lung ultrasound in diagnosis of respiratory...
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Lung Ultrasound in Diagnosis of Respiratory Distress
Muzafar Gani Abdul WahabAssociate Professor, Pediatrics
Chair, TnECHO & POCUSNEO Program
McMaster University, Hamilton Canada
Objectives
• Basics and key principles of Lung Ultrasound
• What is Normal and Abnormal
• How to differentiate in different lung pathologies by US
What we can do with it?
• Diagnostic;
– RDS, TTN, pneumonia, Atelectasis, CLD, pleural effusion, PTX, and CCAM/CPAM.
• Early Prediction of complications;
– LUS can early predict BPD in infants < 29 weeks GA
– Predict the need for surfactant therapy in preterm infants with RDS.
– LUS can predict non-invasive ventilation failure.
– LUS can predict clearance of lung fluids in TTN infants
• Reduce radiation exposure; decrease # CXR requests in NICU
Sensitivity and specificity of LUS
Understand Key principles of LUS
• Simple
• Air & Fluid mix
• All signs arise from pleural line
• Artifacts fundamental
• Dynamic movement
• Acute pathology around pleura
Selection of probe
Attenuation
• Penetration is primarily determined by the center frequency of the transducer,
• The higher the frequency, the shallower the penetration because the absorption of the ultrasound wave traveling through tissue increases with frequency
Likes or dislikes of USG:
https://pubs.rsna.org/doi/full/10.1148/rg.294085199
Penetration of US waves in different tissues
Anatomical Landmarks of LUS
Lung US zones
Bat sign
Pleural Line
Upper rib Lower rib
A line – Normal Lung
• Indicate Air - physiological ”Normal Lung”
• Reverberation artifact, Horizontal repetitive lines parallel to the pleural line
• Equidistant; The distance between two A-lines is equal to the skin-pleural
line distance.
B Line (Compact)
• ( B=Bad)Fluid in the interstitial space or in the alveoli
• Originates from Pleural line
• Reaches to the base of the screen.
• Move with Lung sliding
• Erase A lines
• More then 2 is Abnormal
B line – Coalescent
Means increase severity e.g. RDS, Significant PDA, interstitial lung disease,…etc
C - Consolidation
Pleural line, Lung Sliding
Pleural LineAppear as a shimmering echogenic linear structure
Respiratory cycle: Sliding Sign
Absence of lung sliding: pneumothorax, apnea
Lung pulse / sliding
1. RDS
What is What??:
Double Lung Point - TTN
RDS Vs TTN
RDS Vs TTN
3. Surfactant need
LUS Score
0 1 2 3
Lung US scores
0-30-3
0-3 0-3
0-30-3
Total score: 0 - 18
LUS Score
Sandy Beach / Sea Shore or Stratosphere sign• The sea-shore sign• Normal pleural line
• M-mode (image), a sandy pattern, arising from the pleural line.
• Above the pleural line is a regular pattern, completely distinct from the sandy pattern seen below.
Lung Point - Pneumothorax
M - Mode
Pleural Effusion
Pericardial Effusion
Atelectasis / Pneumonia
RDS
BPD
Normal
Diagnosing Vocal cord Palsy
Right side paralysis
Diagnostic Algorithm
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