Ultrasonography of Pleura and Lung

 

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Abstract

The value of ultrasound examination of the pleura and lungs remains highly underestimated to this day. While the ventilated lungs and the osseous skeleton of the thorax represent potent obstacles for ultrasound, a multitude of pathological processes of the chest wall, pleura, and lungs results in altered tissue composition, providing markedly increased access and visibility for sonographic examination. These conditions support the sonographic diagnosis of pleural and pulmonary disorders. However, the main value of pleura and lung ultrasonography is not the primary diagnosis of chest lesions but the follow up, differential diagnosis, detection of complications, such as abscesses and post embolic lung infarction, and guidance of diagnostic and therapeutic interventions in patients with pathological pleural and pulmonary findings. Punctures and drainages of fluids, e. g., haematothorax, empyema, chylothorax as well as biopsies of solid lesions can safely be performed under ultrasound-guidance. It is of special importance that pleura and lung ultrasonography, as a non-invasive method, can be repeated without discomfort or radiation exposure for the patient and is therefore valuable in the follow-up of pathological findings. Adequate interpretation of sonographic pleura and lung findings has to consider the patient’s history, physical examination, chest X-ray and other results obtained by complementary imaging technologies (e. g. thoracic computed tomography).

Zusammenfassung

Der Wert der Thoraxsonographie ist durch die Annahme, dass der Luftgehalt und das Thoraxskelett generelle Hindernisse für den Ultraschall seien, unterschätzt worden. Eine Vielzahl von pathologischen Prozessen der Pleura und Lunge führt zu einer Änderung der Gewebeeigenschaften und somit zu einer sonographischen Beurteilbarkeit pleuraler und lungenparenchymatöser Krankheiten. Der besondere Wert der Ultraschalldiagnostik der Pleura und Lunge liegt weniger in der Primärdiagnostik, sondern in der Differenzialdiagnostik und Verlaufsbeobachtung, Erkennung von Komplikationen, z. B. Abszessbildung und postembolischer Lungeninfarkt sowie der prompten und sicheren diagnostischen und therapeutischen Interventionsmöglichkeit, z. B. ultraschallgezielte Punktion von Ergüssen zur Erregergewinnung und Abszessdrainage oder Biopsieentnahme von peripher gelegenen Lungentumoren. Die Thoraxsonographie erlaubt insbesondere eine strahlen- und belastungsfreie und nicht-invasive Verlaufskontrolle von pathologischen Befunden. Eine adäquate Interpretation des sonographischen Befundes kann nur im Zusammenhang mit der Anamnese, dem klinischen Untersuchungsbefund, der Röntgenthoraxaufnahme und andere komplementäre Methoden erfolgen.

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