Chest Sonography PDF
Preview Chest Sonography
Chest Sonography Gebhard Mathis Editor Chest Sonography Third Edition Editor Prof. Dr. Gebhard Mathis Internistische Praxis Bahnhofstrasse 16/2 6830 Rankweil Austria [email protected] ISBN 978-3-642-21246-8 e-ISBN 978-3-642-21247-5 DOI 10.1007/978-3-642-21247-5 Springer Heidelberg Dordrecht London New York Library of Congress Control Number: 2011933936 © Springer-Verlag Berlin Heidelberg 2011 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: eStudioCalamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Preface The scope of application of chest sonography has been significantly widened in the last few years. Portable ultrasound systems are being used to an increasing extent in preclinical sonography, at the site of trauma, in the ambulance of the emergency physi- cian or in ambulance helicopters. In the emergency room, at the intensive care unit and in clinical routine, chest sonography has proved its worth as a strategic instrument to be used directly after the clinical investigation. It helps the investigator to decide – very rapidly – whether a traumatized patient is suffering such severe internal hemor- rhage that he or she needs to be transported to the operating room immediately or whether there still is time for further investigations like CT. Several diagnoses such as pneumothorax, pneumonia or pulmonary embolism can be established immediately. The present new issue has been extended to include two subjects. Emergency sonography in the chest is getting more important every year. The evidence of inter- stitial syndrome has shown a significant correlation with extravascular lung water in cases of pulmonary edema and noncardiogenic pulmonary edema. An international consensus conference last year worked out the value of lung ultrasound in several conditions, e.g., pneumothorax, interstitial syndrome and lung consolidation. Newborns, infants and children do not show a different picture than adults at lung ultrasound examination. Also the pathological changes described in adults’ diseases are similar. The use of ultrasound in respiratory diseases of the newborn and the child needs to be encouraged not simply as a valid diagnostic alternative but as a necessary ethical choice. Ultrasound avoids the use of ionising radiation. Therefore sonography reduces the risk of developing malignancies later in life. I am most deeply indebted to the team of authors for their creative cooperation and timely submissions. I also thank Springer-Verlag for their close collaboration and careful production of the book. The purpose of this pictorial atlas is to help colleagues serve their patients better. It will hopefully enable clinicians to establish diagnoses rapidly at the patient’s bed- side with greater accuracy and efficiency, and to initiate appropriate therapeutic mea- sures on time. Rankweil, Austria Gebhard Mathis v Contents 1 Indications, Technical Prerequisites and Investigation Procedure.................................. 1 Sonja Beckh 2 The Chest Wall............................................. 11 Gebhard Mathis and Wolfgang Blank 3 Pleura .................................................. 27 Joachim Reuss 4 Lung Consolidations ........................................ 55 Gebhard Mathis, Sonja Beckh, and Christian Görg 5 Mediastinum............................................... 115 Wolfgang Blank, Jouke T. Annema, Maud Veseliç, and Klaus F. Rabe 6 Endobronchial Sonography .................................. 141 Felix J.F. Herth and Ralf Eberhardt 7 Vascularization............................................. 149 Christian Görg 8 Image Artifacts and Pitfalls .................................. 177 Andreas Schuler 9 Interventional Chest Sonography.............................. 187 Wolfgang Blank 10 The White Hemithorax ...................................... 211 Christian Görg 11 From the Symptom to the Diagnosis ........................... 221 Sonja Beckh 12 Emergency Sonography in the Chest (Excluding Echocardiography)................................ 235 Gebhard Mathis and Joseph Osterwalder 13 Lung Ultrasound in Newborns, Infants, and Children............. 241 Roberto Copetti and Luigi Cattarossi Index ......................................................... 247 vii Indications, Technical Prerequisites 1 and Investigation Procedure Sonja Beckh 1.1 I ndications Sonic shadow zones are caused by nearly complete absorption of the ultrasound wave in bone, especially Sonography is a long-established supplementary imag- behind the sternum, scapula and vertebral column. ing procedure in the diagnosis of pleural effusions. Limitations caused by rib shadows can at least partially Technical advancement and ongoing scientific evidence be balanced by respiratory mechanics. have caused the spectrum of application for sonogra- From a percutaneous route the immediate retroster- phy in diseases of the chest to be steadily extended over nal and posterior portions of the mediastinum cannot the last few years (Broaddus and Light 1994; Müller be viewed. A complementary method for this location 1997; Kinasewitz 1998; Beckh et al. 2002; Fig. 1.1). In is transesophageal and transbronchial sono graphy, clinical routine the ultrasound investigation is a rapid which, however, are invasive investigation procedures orientation guide for differential diagnosis of dyspnea in terms of effort and handling. (Lam and Becker 1996; and pain in the chest (Beaulieu and Marik 2005; Diacon Arita et al. 1996; Silvestri et al. 1996; Becker et al. et al. 2005; Soldati et al. 2006; Arbelot et al. 2008; 1997; Broderick et al. 1997; Serna et al. 1998; Copetti and Cattarossi 2008; Noble et al. 2009). Aabakken et al. 1999; Herth et al. 2004; Fig. 1.3). The sonographic image does not provide a complete Sonography provides diagnostic information overview of the chest; however, it does image a certain when individual structures of the thorax are section of it, which, given a specific problem under investigated: investigation, provides valuable additional information 1. Thorax wall to substantiate overview radiographs. Occasionally (a) Benign lesions sonography is the only noninvasive diagnostic proce- • Benign neoplasms (e.g., lipoma) dure that throws significant light on pathological find- • Hematoma ings (Walz and Muhr 1990; Fraser et al. 1999). • Abscess Up to 99% of the ultrasound wave is reflected in the • Reactivated lymph nodes healthy lung. Intrapulmonary processes can be detected • Perichondritis, Tietze’s syndrome by sonography only when they extend up to the vis- • Rib fracture ceral pleura or can be imaged through a sound-con- (b) Malignant lesions ducting medium such as fluid or consolidated lung • Lymph node metastases (initial diagnosis tissue (Fig. 1.2). and course of disease during treatment) • Invasive, growing carcinomas • Osteolysis 2. Pleura S. Beckh (a) Solid structures: thickening of the pleura, cal- Klinikum Nord, Medizinische Klinik 3, Pneumologie, lus, calcification, asbestosis plaques Prof. Ernst-Nathan-Straße 1, 90419 Nürnberg, Germany e-mail: [email protected] (b) Space-occupying mass G. Mathis (ed.), Chest Sonography, 1 DOI 10.1007/978-3-642-21247-5_1, © Springer-Verlag Berlin Heidelberg 2011 2 S. Beckh In addition to Symptoms X-ray, Ct MRI, PET − Chest pain − Physical examination findings − Palpable lesion − Differentiation solid/liquid − Inflow congestion − Infiltration of pleura/chest wall − Vascularization of the lesion Sonographic and surroundings examination − Real-time examination Orientation Conclusive procedure procedure − Pregnancy − Biopsy/puncture − Breast-feeding − Therapeutic drainage − Bedside/ICU Fig. 1.1 Spectrum of application of sonography for pleural and pulmonary disease 3. Formation of peripheral foci in the lung (a) Benign: inflammation, abscess, embolism, atelectasis (b) Malignant: peripheral metastasis, peripheral carcinoma, tumor/atelectasis 4. Mediastinum, percutaneous (a) Space-occupying masses in the upper anterior medi astinum (b) Lymph nodes in the aorticopulmonary window (c) Thrombosis of the vena cava and its supplying branches Fig. 1.2 Structures and pathological changes accessible to (d) Imaging collateral circulation sonography (e) Pericardial effusion Further pathological alterations in the heart visual- • Benign: fibrous tumor, lipoma ized by sonography will not be described in this book. • Malignant: circumscribed metastases, diffuse For this subject the reader is referred to pertinent text- carcinosis, malignant pleural mesothelioma books on echocardiography. (c) Fluid: effusion, hematothorax, pyothorax, chylothorax (d) Dynamic investigation • Pneumothorax 1.2 Technical Requirements in Terms • Distinguishing between effusion and callus of Equipment formation • Adherence of a space-occupying mass All the apparatuses used for sonographic investigation • Invasion by a space-occupying mass of the abdomen and thyroid may also be used to exam- • Mobility of the diaphragm ine the thorax. A high-resolution linear transducer of
The list of books you might like
