Abstract
This review discusses the usefulness of bedside lung ultrasound in the diagnostic distinction between the various causes of acute dyspnoea in the emergency department, with special attention to the differential diagnosis of pulmonary oedema and exacerbation of chronic obstructive pulmonary disease (COPD). This is made possible by using mid- to low-end scanners and simple acquisition techniques accessible to both radiologists and clinicians. Major advantages include ready availability at the bedside, the absence of ionising radiation, high reproducibility and cost efficiency. The technique is based on the recognition and analysis of sonographic artefacts rather than direct visualisation of the pulmonary structures. These artefacts are caused by the interaction of water-rich structures and air, called comet tails or B-lines. When such artefacts are widely detected on anterolateral transthoracic lung scans, diffuse alveolar-interstitial syndrome can be diagnosed, which is often a sign of acute pulmonary oedema. This condition rules out exacerbation of COPD as the main cause of acute dyspnoea.
Riassunto
In questo lavoro viene discussa l’utilità dell’ecografia polmonare nella diagnosi delle diverse cause di dispnea acuta in emergenza, in particolare focalizzando l’attenzione sulla diagnosi differenziale tra l’edema polmonare e la riacutizzazione della broncopneumopatia cronica ostruttiva (BPCO). Questo è possibile utilizzando anche ecografi di fascia medio-bassa ed avvalendosi di tecniche di facile acquisizione da parte sia dei radiologi che dei clinici. I maggiori vantaggi dell’ecografia includono la sua pronta disponibilità al letto del malato, l’assenza di radiazioni ionizzanti, la riproducibilità ed i costi ridotti. La tecnica è basata sul riconoscimento e l’analisi di alcuni artefatti invece che sulla visualizzazione diretta delle strutture polmonari. Questi artefatti sono causati dalla presenza di strutture ricche di acqua ed aria, e sono chiamati “code di cometa” o linee B. Quando tali artefatti sono diffusamente visualizzati nelle scansioni trans-toraciche antero-laterali, è possibile diagnosticare la sindrome alveolo-interstiziale diffusa, che è spesso un segno di edema polmonare acuto. Questa condizione esclude la riacutizzazione di BPCO quale causa di dispnea acuta.
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Cardinale, L., Volpicelli, G., Binello, F. et al. Clinical application of lung ultrasound in patients with acute dyspnoea: differential diagnosis between cardiogenic and pulmonary causes. Radiol med 114, 1053–1064 (2009). https://doi.org/10.1007/s11547-009-0451-1
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DOI: https://doi.org/10.1007/s11547-009-0451-1