Sonography of the normal lung: Comparison between young and elderly subjects.

BACKGROUND: The senile lung undergoes physiologic changes that are well known but have not been investigated with ultrasound (US). Thus, the aim of our study was to compare the US appearances of the lungs in a group of healthy, nonsmoker elderly subjects with those in a group of young subjects. METHODS: One hundred elderly subjects older than 65 years of age (mean age ± SD, 79 ± 7 years) and 50 younger subjects less than 56 years of age (mean age ± SD, 33 ± 12) underwent US examination of the lungs. We analyzed the anterior, midlateral, and posterobasal surface of each lung to evaluate the presence or absence of A-lines and B-lines. Fisher's exact test and Pearson's χ2 test were used to compare the findings in the two groups. RESULTS: A-lines were absent in 94/100 (94%) elderly subjects versus 2/50 (4%) young subjects (p < 0.0001). B-lines were found in 37/100 (37%) elderly subjects: ≤3 lines per field of view in 27/37 (73%); >3 lines in 2/37 (5%); both ≤3 lines and >3 lines (depending on the region scanned) in 8/37 (22%). In contrast, only in 5/50 (10%) young subjects were B-lines visible (≤3 lines per field of view in all cases [p < 0.001]). CONCLUSIONS: The majority of the elderly subjects did not have A-lines, and B-lines were observed in a high percentage. The reduction of impedance between lung parenchyma and soft tissues of the chest wall and the increased thickness of interlobular septa might explain these results. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:230-234, 2015.

Chest ultrasonography in the ICU.

Chest diagnostic imaging is essential when dealing with a critically ill patient. At present, direct visualization of the lung parenchyma is performed with a chest x-ray and computed tomography with the patient in the supine position. The relative ease of bedside ultrasound examination and the availability of user-friendly, inexpensive, portable equipment have made chest ultrasonography an interesting and alternative method in various situations, because it offers accurate information that is of therapeutic and diagnostic relevance. We describe equipment and examination technique, normal findings, and chest ultrasonography signs detected in some pathological situations, such as pneumothorax, consolidations, pleural effusions, ARDS, and pulmonary edema.

Using sonography to assess lung recruitment in patients with acute respiratory distress syndrome.

The purpose of managing acute respiratory distress syndrome (ARDS) is "to open a closed lung" by increasing the airway pressure or changing the patient's position. Assessment of recruitment of atelectatic lung regions is necessary to have a correct management of mechanical ventilation and to be sure of positive end-expiratory pressure or prone position efficacy before their application. In fact, both of them could have collateral effects. Sonographic approach allows a dynamic evaluation of lung recruitment in patients affected by ARDS and it is easy to perform bedside. In particular, it is useful for patients too unstable to be moved to the CT room. Sonography is fast, cheap, and radiation free; thus, it can be repeated in order to monitor the evolution of ARDS. To our knowledge, the use of this technique in the setting of ARDS was never reported before.