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Lung ultrasound in diagnosing and monitoring pulmonary interstitial fluid

Ecografia polmonare nella diagnosi e nel monitoraggio dei fluidi interstiziali polmonari

  • Chest Radiology / Radiologia Toracica
  • Published:
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Abstract

Chronic heart failure is a complex clinical syndrome often characterised by recurrent episodes of acute decompensation. This is acknowledged as a major public health problem, leading to a steadily increasing number of hospitalisations in developed countries. In decompensated heart failure, the redistribution of fluids into the pulmonary vascular bed leads to respiratory failure, a common cause of presentation to the emergency department. The ability to diagnose, quantify and monitor pulmonary congestion is particularly important in managing the disease. Lung ultrasound (US) is a relatively new method that has gained a growing acceptance as a bedside diagnostic tool to assess pulmonary interstitial fluid and alveolar oedema. The latest developments in lung US are not because of technological advance but are based on new applications and discovering the meanings of specific sonographic artefacts designated as B-lines. Real-time sonography of the lung targeted to detection of B-lines allows bedside diagnosis of respiratory failure due to impairment of cardiac function, as well as quantification and monitoring of pulmonary interstitial fluid. Lung US saves time and cost, provides immediate information to the clinician and relies on very easy-toacquire and highly reproducible data.

Riassunto

L’insufficienza cardiaca cronica è una complessa sindrome clinica caratterizzata spesso da episodi ricorrenti di scompenso acuto. Tale condizione rappresenta uno dei maggiori problemi di salute pubblica, che porta ad un numero sempre crescente di ospedalizzazione nei paesi più sviluppati. Nella insufficienza cardiaca scompensata, la redistribuzione dei fluidi nel letto vascolare polmonare comporta l’insufficienza respiratoria, una causa comune di presentazione nel Dipartimento di Emergenza. La capacità di diagnosticare, quantificare e monitorare la congestione polmonare è di particolare importanza nel trattamento di questa malattia. L’ecografia polmonare è un metodo relativamente nuovo, oramai sempre più diffusamente riconosciuto come mezzo diagnostico utile per la valutazione dell’edema interstiziale ed alveolare al letto del paziente. Il recente sviluppo dell’ecografia polmonare non è legato allo sviluppo tecnologico, ma è basato sulle nuove applicazioni e sulla scoperta del significato di specifici artefatti ecografici chiamati linee B. L’ecografia polmonare mirata alla identificazione delle linee B permette la diagnosi al letto del paziente in tempo reale dell’insufficienza respiratoria dovuta a scompenso cardiaco, cosÌ come la quantificazione ed il monitoraggio della congestione polmonare. La tecnica ecografica polmonare riduce i tempi ed i costi diagnostici, e si basa su segni semplici da identificare ed altamente riproducibili che forniscono immediate informazioni nella gestione del paziente.

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Authors and Affiliations

  1. Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy

    G. Volpicelli, A. Lamorte & M. F. Frascisco

  2. Department of Emergency Medicine, New York Methodist Hospital, New York, NY, USA

    L. A. Melniker

  3. Institute of Radiology, San Luigi Gonzaga University Hospital, Torino, Italy

    L. Cardinale

  4. S.C.D.U. Radiologia, Ospedale San Luigi Gonzaga, Regione Gonzole 10, Orbassano, 10040, Torino, Italy

    L. Cardinale

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  1. G. Volpicelli
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  2. L. A. Melniker
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  3. L. Cardinale
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  4. A. Lamorte
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  5. M. F. Frascisco
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Correspondence to L. Cardinale.

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Volpicelli, G., Melniker, L.A., Cardinale, L. et al. Lung ultrasound in diagnosing and monitoring pulmonary interstitial fluid. Radiol med 118, 196–205 (2013). https://doi.org/10.1007/s11547-012-0852-4

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