Skip to main content

Advertisement

SpringerLink
Log in

The promising role of lung ultrasound in systemic sclerosis

  • Review Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Ultrasound (US) has an emergent and relevant role in the assessment of systemic sclerosis (SSc) even if there are many fields and applications that still have not been sufficiently explored. In this review, we will report an update of the available data regarding the use of US in lung involvement that might cause disability and mortality in SSc patients. Lung US does not employ ionizing radiation and is more rapid and less expensive than traditional high-resolution tomography (HRCT). Furthermore, recent initial studies have demonstrated that US scores correlated to HRCT and functional respiratory test results in SSc interstitial lung disease. The research agenda for the future should include a more profound investigation of its specificity (comparison with healthy subjects and other diseases) and sensitivity to change at follow-up, to adequately disseminate its use in daily practice and clinical trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CT:

Computerized tomography

DLCO:

Carbon monoxide lung diffusion

HRCT:

High-resolution computerized tomography

ILD:

Interstitial lung disease

PFTs:

Pulmonary function tests

SSc:

Systemic sclerosis

US:

Ultrasound

References

  1. Kaloudi O, Bandinelli F, Filippucci E et al (2010) High frequency ultrasound measurement of digital dermal thickness in systemic sclerosis. Ann Rheum Dis 69:1140–1143

    Article  PubMed  Google Scholar 

  2. Iagnocco A, Kaloudi O, Perella C et al (2010) Ultrasound elastography assessment of skin involvement in systemic sclerosis: lights and shadows. J Rheumatol 37:1688–1691

    Article  PubMed  Google Scholar 

  3. Bandinelli F, Kaloudi O, Miniati I et al (2010) Early detection of median nerve syndrome at the carpal tunnel with high-resolution 18 MHz ultrasonography in systemic sclerosis patients. Clin Exp Rheumatol S62:15–18

    Google Scholar 

  4. Bandinelli F, Matucci Cerinic M (2011) Ultrasound in scleroderma. Curr Rheumatol Rev 7:1–7

    Article  Google Scholar 

  5. Silver RM (1996) Scleroderma. Clinical problems. The lungs. Rheum Dis Clin North Am 22:825–840

    Article  PubMed  CAS  Google Scholar 

  6. Steen VD, Medsger TA (2007) Changes in causes of death in systemic sclerosis, 1972–2002. Ann Rheum Dis 66:940–944

    Article  PubMed  Google Scholar 

  7. Wells AU, Steen V, Valentini G (2009) Pulmonary complications: one of the most challenging complications of systemic sclerosis. Rheumatology (Oxford) 48:iii40–iii44

    Article  Google Scholar 

  8. D’Angelo WA, Fries JF, Masi AT et al (1969) Pathologic observations in systemic sclerosis (scleroderma); a study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med 46:428–440

    Article  PubMed  Google Scholar 

  9. Wells AU, Cullinan P, Hansell DM et al (1994) Fibrosing alveolitis associated to systemic sclerosis has a better prognosis than lone cryptogenic fibrosing alveolitis. Am J Respir Crit Care Med 149:1583–1590

    PubMed  CAS  Google Scholar 

  10. Diot E, Boissinot E, Asquier E et al (1998) Relationship between abnormalities on high resolutionct and pulmonary function in systemic sclerosis. Chest 114:1623–1629

    Article  PubMed  CAS  Google Scholar 

  11. Wells AU, Rubens MB, du Bois RM et al (1993) Serial CT in fibrosing alveolitis: prognostic significance of the initial pattern. AJR Am J Roentgenol 161:1159–1165

    PubMed  CAS  Google Scholar 

  12. Ostojic P, Damjanov N (2006) Different clinical features in patients with limited and diffuse cutaneous systemic sclerosis. Clin Rheumatol 25:453–457

    Article  PubMed  Google Scholar 

  13. Morelli S, Barbieri C, Sgreccia A et al (1997) Relationship between cutaneous and pulmonary involvement in systemic sclerosis. J Rheumatol 24:81–85

    PubMed  CAS  Google Scholar 

  14. Toya SP, Tzelepis GE (2009) The many faces of scleroderma sine scleroderma: a literature review focusing on cardiopulmonary complications. Rheumatol Int 29:861–868

    Article  PubMed  Google Scholar 

  15. Matucci Cerinic M, Steen V, Nash P, Hachulla E (2009) The complexity of managing systemic sclerosis: screening and diagnosis. Rheumatology (Oxford) 48:iii8–iii13

    Article  CAS  Google Scholar 

  16. Avouac J, Fransen J, Walker UA et al (2011) Preliminary criteria for the very early diagnosis of systemic sclerosis: results of a Delphi Consesus Study from EULAR Scleroderma Trials and Research Group. Ann Rheum Dis 70:476–481

    Article  PubMed  CAS  Google Scholar 

  17. Hunninghake GW, Zimmerman MB, Schwartz MI et al (2001) Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Med 164:193–196

    CAS  Google Scholar 

  18. Lynch DA, Travis WD, Muller NL et al (2005) Idiopathic interstitial pneumonias: CT features. Radiology 236:10–21

    Article  PubMed  Google Scholar 

  19. Kr F, Thwaite EL, Kazerooni EA et al (2003) Radiological versus histological diagnosis in UIP and NSIP: survival implications. Thorax 58:143–148

    Article  Google Scholar 

  20. Steen VD (2005) The lung in systemic sclerosis. J Clin Rheumatol 11:40–46

    Article  PubMed  Google Scholar 

  21. Goh NS, Veeraraghavan S, Desai SR et al (2008) Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med 177:1248–1254

    Article  PubMed  Google Scholar 

  22. Steen VD, Graham G, Conte C et al (1992) Isolated diffusing capacity reduction in systemic sclerosis. Arthritis Rheum 35:765–770

    Article  PubMed  CAS  Google Scholar 

  23. Wells AU, Hansell DM, Rubens MB et al (1997) Fibrosing alveolitis in systemic sclerosis: indices of lung function in relation to the extent of disease on computerized tomography. Arthritis Rheum 40:1229–1236

    PubMed  CAS  Google Scholar 

  24. Best AC, Meng J, Lynch AM et al (2008) Idiopathic pulmonary fibrosis: physiological tests, quantitative CT indices and CI visual scores as predictor of mortality. Radiology 246:935–940

    Article  PubMed  Google Scholar 

  25. Lichtenstein DA, Meziere G, Biderman P et al (1997) The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 156:1640–1646

    PubMed  CAS  Google Scholar 

  26. Zoltan J, Monti C, Coppola V et al (2004) Usefulness of ultrasound comets as a nonradiologic sign of extravascular lung water. Am J Cardiol 93:1265–1270

    Article  Google Scholar 

  27. Frassi F, Gargani L, Gligorova S et al (2007) Clinical and ecocardiographic determinants of ultrasound lung comets. Eur J Echocariogr 8:474–479

    Article  Google Scholar 

  28. Lichtenstein DA (2007) Ultrasound in the management of thoracic disease. Crit Care Med 5(Suppl):S250–S261

    Article  Google Scholar 

  29. Jambrik Z, Monti S, Coppola V et al (2004) Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am J Cardiol 93:1265–1270

    Article  PubMed  Google Scholar 

  30. Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Margonato A, Picano E (2005) “Ultrasound comet-tail imags”: a marker of pulmonary edema. A comparative study with wedge pressure and extravascular lung water. Chest 127:1690–1695

    Article  PubMed  Google Scholar 

  31. Gargani L, Lionetti V, Di Cristofano C, Bevilacqua G, Recchia FA, Picano E (2007) Early detection of acute lung injury uncoupled to hypoxemia in pigs using ultrasound lung comets. Crit Care Med 35:2769–2774

    Article  PubMed  Google Scholar 

  32. Jambrick Z, Gargani L, Adamcza A, Kaszaki J, Varga A, Forster T, Boros M, Picano E (2010) B-lines quantify the lung water content: a lung ultrasound versus lung gravimetry study in acute lung injury. Ultrasound Med Biol 36:2004–2010

    Article  Google Scholar 

  33. Pistolesi M, Giuntini C (1978) Assessment of extravascular lung water. Radiol Clin North Am 15:551–574

    Google Scholar 

  34. Picano E, Frassi F, Agricola E et al (2006) Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr 19:356–363

    Article  PubMed  Google Scholar 

  35. Doveri M, Frassi F, Consensi A et al (2008) Ultrasound lung comets: new echographic sign of lung interstitial fibrosis in systemic sclerosis. Reumatismo 60:180–184

    PubMed  CAS  Google Scholar 

  36. Gargani L, Doveri M, D’Errico L et al (2009) Ultrasound lung comets in systemic sclerosis: a chest sonography hallmark of pulmonary interstitial fibrosis. Rheumatology (Oxford) 48:1382–1387

    Article  Google Scholar 

  37. Warrick JH, Bhalla M, Schabel SI et al (1991) High resolution computed tomography in early scleroderma lung disease. J Rheumatol 18:1520–1528

    PubMed  CAS  Google Scholar 

  38. Delle Sedie A, Doveri M, Frassi F et al (2010) Ultrasound lung comets in systemic sclerosis: a useful tool to detect lung interstitial fibrosis. Clin Exp Rheumatol 28(Suppl 57):s54

    PubMed  CAS  Google Scholar 

  39. Gutierrez M, Salaffi F, Carotti M et al (2011) Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders—preliminary results. Arthritis Res Ther 13:R134

    Article  PubMed  Google Scholar 

  40. Frassi F, Pingitore A, Cialoni D, Picano E (2008) Chest sonography detects lung water accumulation in healthy elite apnea divers. J Am Soc Echocardiogr 21:1150–1155

    Article  PubMed  Google Scholar 

  41. Pratali L, Cavana M, Sicari R, Picano E (2010) Frequent subclinical high-altitude pulmonary edema detected by chest sonography as ultrasound lung comets in recreational climbers. Crit Care Med 38:1818–1823

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Our grateful thanks go to Dr. Francesca Bandinelli for her critical reading of the manuscript.

Disclosures

None.

Author information

Authors and Affiliations

  1. Rheumatology Unit, University of Pisa, Pisa, Italy

    A. Delle Sedie, L. Carli, E. Cioffi, S. Bombardieri & L. Riente

  2. U.O. Reumatologia, University of Pisa, Via Roma 67, 56126, Pisa, Italy

    A. Delle Sedie

Authors
  1. A. Delle Sedie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Carli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Cioffi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Bombardieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. Riente
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Delle Sedie.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Delle Sedie, A., Carli, L., Cioffi, E. et al. The promising role of lung ultrasound in systemic sclerosis. Clin Rheumatol 31, 1537–1541 (2012). https://doi.org/10.1007/s10067-012-2030-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-012-2030-4

Keywords

Search

Navigation