Look at the lung: can chest ultrasonography be useful in pregnancy?

Riccardo Inchingolo, Andrea Smargiassi, Flaminio Mormile, Roberta Marra, Sara De Carolis, Antonio Lanzone, Salvatore Valente, Giuseppe M Corbo, Riccardo Inchingolo, Andrea Smargiassi, Flaminio Mormile, Roberta Marra, Sara De Carolis, Antonio Lanzone, Salvatore Valente, Giuseppe M Corbo

Abstract

Background: This study aimed to evaluate the clinical value of chest ultrasound (US) in the detection, diagnosis and follow-up of pathologic processes of both peripheral lung parenchyma and pleural space in pregnant women.

Findings: Pregnant women admitted to Obstetric Pathology Hospital Department for respiratory diseases were enrolled. Chest US examination was performed when there was a respiratory disease highly suggestive of pneumonia and/or pleural effusion and chest X-ray (CXR) should have been obtained. Three chest US patterns were identified: lung consolidation (LC), pleural effusion (PE) and focal sonographic interstitial syndromes (SIS). When chest US pathologic signs were reported, one or more subsequent chest US examinations were performed to follow-up the patient until their complete resolution. Sixteen inpatients underwent 54 chest US evaluations. We identified: 9 LCs, 6 PEs and 11 SISs. Total number of CXRs was 7 (10 females avoided X-rays exposure and one underwent 2 CXR evaluations on the advice of Gynecologist). Chest US follow-up, during and after therapy, showed complete resolution of echographic patterns previously described.

Conclusions: Chest US evaluation during pregnancy is a useful diagnostic tool to detect and monitor respiratory diseases, avoiding excessive X-rays exposure.

Keywords: Chest ultrasound; Pleural disease; Pneumonia; Pregnancy; Thoracic imaging.

Figures

Figure 1
Figure 1
Chest ultrasonographic patterns: lung consolidation (A), pleural effusion (B) and sonographic interstitial syndrome (C).
Figure 2
Figure 2
Two cases of difficult to detect CXR pathologic signs managed by chest US. Patient A: On the left: CXR reported difficult-to-detect pulmonary consolidation of the left lower lobe consistent with retrocardiac pneumoniax. In the middle: The ultrasound assessment with linear array probe shows delimitated subpleural hypoechoic solid structures surfacing in pleura. Focal pulmonary edema related to inflammatory effects is found near lung consolidations. These findings are associated with small lung consolidations consistent with pneumonia. On the right: Normalized Chest US pattern after therapy. Patient B: CXR performed in anterior-posterior (at top left) and lateral scans (at bottom left) did not show easily detectable pathologic findings. In the middle: The ultrasound assessment with convex probe showed focal echographic interstitial syndrome and focal alterations of the pleural line of a limited dorsal region of the left lower lobe (at top). A minimal free flowing left pleural effusion, limited to costo-phrenic sinus same-sided with the focal echographic interstitial syndrome (at bottom). On the right: Visualization of curtain sign on spleen without evidence of pleural effusion after therapy.

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