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Images in Thorax
Visual identification of pulmonary ventilation and perfusion: a new application of lung ultrasound
  1. Guido Tavazzi1,2,
  2. Francisca Ana Caetano2,
  3. Sachin Shah2,
  4. Joana Alcada2,3,
  5. Susanna Price2
  1. 1Department of Anesthesia and Intensive Care and Emergency Department, Fondazione IRCC Policlinico San Matteo, University of Pavia, Pavia, Italy
  2. 2Adult Intensive Care Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
  3. 3National Heart and Lung institute, Imperial College, London, UK
  1. Correspondence to Dr Guido Tavazzi, Fondazione IRCC Policlinico San Matteo, Piazzale Golgi 19, Pavia 27100 Italy; gtavazzi{at}

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A 32-year-old lady with a history of haemochromatosis with iron infiltration of the myocardium and aplastic anaemia was admitted with H1N1-related severe adult respiratory distress syndrome with dense bilateral consolidations in all lobes at chest X-ray and CT scan (figure 1A, B). The severe hypoxaemia requiring mechanical ventilation and refractory to inhaled nitric oxide and pronation led ultimately to venovenous extracorporeal membrane oxygenation placement. Transthoracic echocardiography (TTE) demonstrated a mildly biventricular systolic impairment alike the last TTE done during the follow-up for the haemochromatosis, without any intracardiac shunt as demonstrated by agitated-saline bubble study. Lung ultrasound (LUS) showed bilateral complete consolidation of the lung (tissue-like pattern) in the mid-lower lobes, which was present from admission. …

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