2. Updates in Chest
Sonography
By
Gamal Rabie Agmy , MD , FCCP
Professor of Chest Diseases ,Assiut University

4. • Diagnostic ultrasonography
is the only clinical imaging
technology currently in use
that does not depend on
electromagnetic radiation.

5. Ultrasound Transducer
• Acts as both speaker & microphone
 Emits very short sound pulse
 Listens a very long time for returning echoes
• Can only do one at a time
Speaker
Microphone
transmits sound pulses
receives echoes

6. High Frequency
• High frequency (5-10 MHz)
greater resolution
less penetration
• Shallow structures
vascular, abscess, t/v gyn,
testicular

7. Low Frequency
• Low frequency (2-3.5 MHz)
greater penetration
less resolution
• Deep structures
Aorta, t/a gyn, card, gb, renal

8. Probes

9. A common language: Color Coding
Black
Grey
White

10. Hyperechoic
Hypoechoic
Anechoic

11. Scanning Positions for
Chest Sonography

15. Normal Anatomy

21. Normal lung surface
Left panel: Pleural line and A line (real-time).
The pleural line is located 0.5 cm below the rib line in the adult.
Its visible length between two ribs in the longitudinal scan is
approximately 2 cm. The upper rib, pleural line, and lower rib (vertical
arrows) outline a characteristic pattern called the bat sign.

34. the "seashore sign" (Fig.3).

36. The key sonographic signs of
Pneumothorax
Absent lung sliding
Exaggerated horizontal artifacts
Loss of comet-tail artifacts
Broadening of the pleural line to a band
Lung point
Loss of lung impulse

47. Pulmonary Embolism

48. Schematic representation of the parenchymal, pleural and vascular
features associated with pulmonary embolism.(Angelika Reissig, Claus
Kroegel. Respiration 2003;70:441-452 )

50. Duplex Doppler sonogram of a 5 x 3 cm hypoechoic mass
(adenocarcinoma) in upper lobe of left lung shows blood flow
at margin of tumor near pleura. Spectral waveform reveals
arteriovenous shunting: low-impedance flow with high
systolic and diastolic velocities. Pulsatility index = 0.90,
resistive index = 0.51, peak systolic velocity = 0.47 m/sec, end
diastolic velocity =0.23 m/sec, peak frequency shift = 3.8 kHz,

51. Duplex Doppler sonogram in 67-year-old man with pulmonary
tuberculosis in lower lobe of left lung shows several blue and
red flow signals in massiike lesion. Spectral waveform reveals
high-impedance flow. Pulsetility index = 4.20, resistive index =
0.93, peak systolic velocity = 0.45 m/sec, end diastolic
velocity = 0.03 m/sec, Doppler angle = 21#{

52. Alveolar-interstitial
syndrome

57. Contrast-enhanced ultrasonography
of pneumonia
A: Baseline scan shows
a
hypoechoic
consolidated area
B: Seven seconds after
iv bolus of contrast
agent, the lesion shows
marked
and
homogeneous
enhancement
C: The lesion remains
substantially unmodified
after 90 s.

58. Lung abscess at CEUS
.A: An anechoic oval
lesion is surrounded
by an echodense
capsule;
B: After iv bolus of
contrast agent, the
lesion shows no
contrast agent uptake,
whereas the capsule is
strongly enhanced

59. Contrast-enhanced
ultrasonography of
pulmonary infarction
After iv bolus of
contrast agent, the
lesion shows no
contrast agent
uptake in the
arterial phase,
which suggests
the absence of
blood supply.

60. Bronchial carcinoma infiltrating the pleural wall.
A: Posterior intercostal scan shows a
hypoechoic lesion accompanied by rib
destruction (arrows);
B: Twenty-four seconds after iv bolus of contrast agent, the lesion
appears inhomogeneously enhanced; the disrupted rib appears
more echogenic than the tumor (arrowheads), as a consequence of
the incomplete tissue suppression due to the strong echogenicity
of bone tissue.

61. Contrast-enhanced ultrasonography of bronchial
carcinoma
A: Baseline scan shows a hypoechoic
lesion with irregular borders
Ten seconds after iv bolus of
contrast agent, the pulmonary
parenchyma near the lesion is
already enhanced (arrows),
whereas the lesions is still
unenhanced
B: Twenty seconds later, the lesion
shows delayed inhomogeneous
enhancement, which indicates a
preferential bronchial arterial supply

70. Ultrasound-Guided Peripheral
IV Placement

71. Ultrasound evaluation of
diaphragm

72. (Chest. 2008; 133:836-837)
© 2008 American College of Chest
Physicians
Ultrasound: The Pulmonologist’s New
Best Friend
Momen M. Wahidi, MD, FCCP
Durham, NC
Director, Interventional Pulmonology, Duke
University Medical Center, Box 3683,
Durham, NC 27710