Sonographic lobe localization of alveolar-interstitial syndrome in the critically ill

Konstantinos Stefanidis, Stavros Dimopoulos, Chrysafoula Kolofousi, Demosthenes D Cokkinos, Katerina Chatzimichail, Lewis A Eisen, Mitchell Wachtel, Dimitrios Karakitsos, Serafim Nanas, Konstantinos Stefanidis, Stavros Dimopoulos, Chrysafoula Kolofousi, Demosthenes D Cokkinos, Katerina Chatzimichail, Lewis A Eisen, Mitchell Wachtel, Dimitrios Karakitsos, Serafim Nanas

Abstract

Introduction. Fast and accurate diagnosis of alveolar-interstitial syndrome is of major importance in the critically ill. We evaluated the utility of lung ultrasound (US) in detecting and localizing alveolar-interstitial syndrome in respective pulmonary lobes as compared to computed tomography scans (CT). Methods. One hundred and seven critically ill patients participated in the study. The presence of diffuse comet-tail artifacts was considered a sign of alveolar-interstitial syndrome. We designated lobar reflections along intercostal spaces and surface lines by means of sonoanatomy in an effort to accurately localize lung pathology. Each sonographic finding was thereafter grouped into the respective lobe. Results. From 107 patients, 77 were finally included in the analysis (42 males with mean age = 61 ± 17 years, APACHE II score = 17.6 ± 6.4, and lung injury score = 1.0 ± 0.7). US exhibited high sensitivity and specificity values (ranging from over 80% for the lower lung fields up to over 90% for the upper lung fields) and considerable consistency in the diagnosis and localization of alveolar-interstitial syndrome. Conclusions. US is a reliable, bedside method for accurate detection and localization of alveolar-interstitial syndrome in the critically ill.

Figures

Figure 1
Figure 1
Anterior view of the lung. Schematic representation of pulmonary lobes in relation to ribs and intercostal spaces along parasternal (PS) and midclavicular (MD) lines, respectively. Dashed lines correspond to major and minor lung fissures (RUL: right upper lobe; RML: right mid lobe, RLL: right lower lobe; LUL: left upper lobe; LLL: left lower lobe).
Figure 2
Figure 2
Lateral view of the right lung. Schematic representation of pulmonary lobes in relation to ribs and intercostal spaces along anterior axillary (AA), midaxillary (MD), and posterior axillary (PA) lines, respectively.
Figure 3
Figure 3
Lateral view of the left lung. Schematic representation of pulmonary lobes in relation to ribs and intercostal spaces along anterior axillary (AA), midaxillary (MD), and posterior axillary (PA) lines, respectively.
Figure 4
Figure 4
Computed tomography (CT) scans showing areas of “ground glass” opacification and bilateral-dependent areas of dense consolidation in a patient with acute respiratory distress syndrome (right panel). Lung ultrasound scans in the same patient depicting B-lines arising from the pleural line, confirming thus a pattern of diffuse alveolar-interstitial syndrome (left panel).
Figure 5
Figure 5
Cohen's kappa values by lobe of lung, with lines displaying bootstrap 95% confidence intervals.

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