Ultrasound diagnosis of alveolar consolidation in the critically ill
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Alveolar consolidation is a basic concern in critically ill patients. Radiography is not a precise tool, and referral to CT raises problems (transport, irradiation). The aim of this study was to assess the utility of ultrasound in the diagnosis of alveolar consolidation.
Prospective clinical study.
The medical ICU of a university-affiliated teaching hospital.
A total of 65 cases of alveolar consolidation proven on CT were compared to 53 CT controls.
Alveolar consolidation was defined as a tissue-like pattern visible at the chest wall, arising from the pleural line and devoid of centrifugal inspiratory dynamics.
Feasibility was 99%. In 65 cases of alveolar consolidation, ultrasound was positive in 59 and negative in 6. In 52 analyzable controls, ultrasound was negative in 51 and positive in 1. Sensitivity of ultrasound was 90% and specificity 98%. A concordance test showed a Kappa coefficient of 0.89. Among 62 posterior locations on CT, ultrasound showed posterior consolidation patterns in 56 cases and was negative in 6. Ultrasound showed anterior involvement in all 3 cases of whole lung consolidation.
Ultrasound provides a reliable non-invasive, bedside method for accurate detection and location of alveolar consolidation in critically ill patients.
KeywordsChest ultrasonography Ultrasound diagnosis Lungs Respiratory failure Alveolar consolidation Intensive care unit
We wish to thank David Marsh, PhD, for the translation of this study, Philippe Aegerter, MD, and Gauthier Maillard, MD, for their precious advice. The X-.rays and CTs were taken at the department of Prof. Pascal Lacombe, to whom we are grateful. Lastly, we thank Prof. François Jardin who made this work possible.
- 8.Weinberger SE, Drazen JM (2001) Disturbances of respiratory function. In Braunwald E, Fauci AS, Kaspar DL, Hauser SL,Longo DL (eds) Harrison’s principles of internal medicine, 15th edn. McGraw-Hill, New York p 1454Google Scholar
- 9.Lichtenstein D (2001) Lung ultrasound in the intensive care unit. Recent Res Dev Resp Crit Care Med 1:83–93Google Scholar
- 16.Lichtenstein D, Mezière G, Seitz J (2002) Le “bronchogramme aérien dynamique”, un signe échographique de consolidation alvéolaire non rétractile. Reanimation 11 [Suppl 3]:98sGoogle Scholar
- 22.Lichtenstein D (2002) L’échographie générale en réanimation (General ultrasound in the intensive care unit), 2nd edn. Springer, Heidelberg Paris Berlin New York, pp 1–213Google Scholar
- 23.Lichtenstein D, Mezière G (1998) Apprentissage de l’échographie générale d’urgence par le réanimateur. Reanimation Urg 7 [Suppl 1]:108Google Scholar
- 24.Dénier A (1946) Les ultrasons, leur application au diagnostic. Presse Med 22:307–308Google Scholar