Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound(T...Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound(TUS) with conventional(chest X-rays-) and more advanced imaging procedures(computed tomography and magnetic resonance imaging) implies advantages, limitations and actual problems. Indeed, despite TUS may provide useful imaging of pleura, lung and heart disease, emergency scenarios are currently the most warranted field of application of TUS: Pleural effusion, pneumothorax, lung consolidation. This stems from its role in limited resources subsets; actually, ultrasound is an excellent risk reducing tool, which acts by:(1) increasing diagnostic certainty;(2) shortening time to definitive therapy; and(3) decreasing problems from blind procedures that carry an inherent level of complications. In addition, paediatric and newborn disease are particularly suitable for TUS investigation, aimed at the detection of congenital or acquired chest disease avoiding, limiting or postponing radiological exposure. TUS improves the effectiveness of elective medical practice, in resource-limited settings, in small point of care facilities and particularly in poorer countries. Quality and information provided by the procedure are increased avoiding whenever possible artefacts that can prevent or mislead the achievement of the correct diagnosis. Reliable monitoring of patients is possible, taking into consideration that appropriate expertise, knowledge, skills, training, and even adequate equipment's suitability are not always and everywhere affordable or accessible. TUS is complementary imagingprocedure for the radiologist and an excellent basic diagnostic tool suitable to be shared with pneumologists, cardiologists and emergency physicians.展开更多
Emergency physicians are required to care for unstable patients with life-threatening conditions, and thus must make decisions that are both quick and precise about unclear clinical situations. There is increasing con...Emergency physicians are required to care for unstable patients with life-threatening conditions, and thus must make decisions that are both quick and precise about unclear clinical situations. There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations. B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago. Its application in the diagnosis of thoracic diseases has always been considered limited, due to the presence of air in the lung and the presence of the bones of the thoracic cage, which prevent the progression of the ultrasound beam. However, the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds. At the bedside, thoracic ultrasound is based primarily on the analysis of these artifacts, with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly "water-rich" or "air-rich". The indications, contraindications, advantages, disadvantages, and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.展开更多
目的分析胸部超声和CT在重症监护室(intensive care unit,ICU)患者并发肺部感染的诊断价值。方法将2018年5月至2021年5月在浙江中医药大学附属温州中医院ICU住院治疗的103例疑似肺部感染患者纳入本研究中,均先后接受胸部CT、超声检查,...目的分析胸部超声和CT在重症监护室(intensive care unit,ICU)患者并发肺部感染的诊断价值。方法将2018年5月至2021年5月在浙江中医药大学附属温州中医院ICU住院治疗的103例疑似肺部感染患者纳入本研究中,均先后接受胸部CT、超声检查,保留完整图像,分析其征象表现,并以肺部感染金标准,比较分析两者的诊断效能。结果103例患者确诊肺部感染76例,无感染27例。超声征象主要是胸膜线异常,A、B线异常、肺实变及胸腔积液;CT征象主要是磨玻璃影、实变影及网格影或狭长细线样影等征象混合存在。CT诊断特异性为77.78%,敏感度为90.78%,准确度为87.38%,超声分别为74.04%、88.16%、84.47%,两种检查分别比较,差异无统计学意义(P>0.05)。结论胸部超声和CT在肺部感染诊断中均有良好效能,均有较高且一致的诊断准确性,对ICU患者可应用床旁胸部超声进行肺部感染诊断。展开更多
文摘Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound(TUS) with conventional(chest X-rays-) and more advanced imaging procedures(computed tomography and magnetic resonance imaging) implies advantages, limitations and actual problems. Indeed, despite TUS may provide useful imaging of pleura, lung and heart disease, emergency scenarios are currently the most warranted field of application of TUS: Pleural effusion, pneumothorax, lung consolidation. This stems from its role in limited resources subsets; actually, ultrasound is an excellent risk reducing tool, which acts by:(1) increasing diagnostic certainty;(2) shortening time to definitive therapy; and(3) decreasing problems from blind procedures that carry an inherent level of complications. In addition, paediatric and newborn disease are particularly suitable for TUS investigation, aimed at the detection of congenital or acquired chest disease avoiding, limiting or postponing radiological exposure. TUS improves the effectiveness of elective medical practice, in resource-limited settings, in small point of care facilities and particularly in poorer countries. Quality and information provided by the procedure are increased avoiding whenever possible artefacts that can prevent or mislead the achievement of the correct diagnosis. Reliable monitoring of patients is possible, taking into consideration that appropriate expertise, knowledge, skills, training, and even adequate equipment's suitability are not always and everywhere affordable or accessible. TUS is complementary imagingprocedure for the radiologist and an excellent basic diagnostic tool suitable to be shared with pneumologists, cardiologists and emergency physicians.
文摘Emergency physicians are required to care for unstable patients with life-threatening conditions, and thus must make decisions that are both quick and precise about unclear clinical situations. There is increasing consensus in favor of using ultrasound as a real-time bedside clinical tool for clinicians in emergency settings alongside the irreplaceable use of historical and physical examinations. B-mode sonography is an old technology that was first proposed for medical applications more than 50 years ago. Its application in the diagnosis of thoracic diseases has always been considered limited, due to the presence of air in the lung and the presence of the bones of the thoracic cage, which prevent the progression of the ultrasound beam. However, the close relationship between air and water in the lungs causes a variety of artifacts on ultrasounds. At the bedside, thoracic ultrasound is based primarily on the analysis of these artifacts, with the aim of improving accuracy and safety in the diagnosis and therapy of the various varieties of pulmonary pathologic diseases which are predominantly "water-rich" or "air-rich". The indications, contraindications, advantages, disadvantages, and techniques of thoracic ultrasound and its related procedures are analyzed in the present review.
文摘目的分析胸部超声和CT在重症监护室(intensive care unit,ICU)患者并发肺部感染的诊断价值。方法将2018年5月至2021年5月在浙江中医药大学附属温州中医院ICU住院治疗的103例疑似肺部感染患者纳入本研究中,均先后接受胸部CT、超声检查,保留完整图像,分析其征象表现,并以肺部感染金标准,比较分析两者的诊断效能。结果103例患者确诊肺部感染76例,无感染27例。超声征象主要是胸膜线异常,A、B线异常、肺实变及胸腔积液;CT征象主要是磨玻璃影、实变影及网格影或狭长细线样影等征象混合存在。CT诊断特异性为77.78%,敏感度为90.78%,准确度为87.38%,超声分别为74.04%、88.16%、84.47%,两种检查分别比较,差异无统计学意义(P>0.05)。结论胸部超声和CT在肺部感染诊断中均有良好效能,均有较高且一致的诊断准确性,对ICU患者可应用床旁胸部超声进行肺部感染诊断。
