Emerging roles for transthoracic ultrasonography in pleuropulmonary pathology

As a result of many advantages, such as absence of radiation exposure, non-invasiveness, low cost, safety, and ready availability, transthoracic ultrasonography (TUS) represents an emerging and useful technique in the management of pleural and pulmonary diseases. In this first part of a comprehensive review dealing with the role of TUS in pleuropulmonary pathology, the examination technique, limits, normal findings, and sonographic artefacts and morphology of the most important and frequent pleural diseases are described. In particular, this first part deals with the capability of TUS in detecting pleural effusion and differentiating pleural fluid from pleural thickening; its usefulness in detecting pneumothorax on the basis of the changes in the artefacts detectable in the normally aerated lung and the appearance of pathologic artefacts; and its role in detecting pleural-based lesions and classifying them into extrapleural, pleural, and parenchymal lesions. Finally, the limits of TUS when compared with computed tomography of the chest are described, highlighting the inability of TUS to depict lesions that are not in contact with the pleura or are located under bony structures, poor visualization of the mediastinum, and the need for very experienced examiners to obtain reliable results.     

US in the diagnosis of pediatric chest diseases.

Most pediatric chest diseases are adequately evaluated with chest radiography. However, when chest radiography does not allow identification of the location and nature of an area of increased opacity, ultrasonography (US) can help establish the diagnosis. US may be helpful in evaluation of persistent or unusual areas of increased opacity in the peripheral lung, pleural abnormalities, and mediastinal widening; US is particularly useful in patients with complete opacification of a hemithorax at radiography. In cases of pulmonary parenchymal lesions, identification of air or fluid bronchograms at US and of pulmonary vessels at color flow imaging is useful for differentiating pulmonary consolidation or atelectasis from lung masses and pleural lesions. US allows characterization of pleural fluid collections as simple, complicated, or fibroadhesive, which is important information for planning thoracentesis or thoracotomy. Computed tomography and magnetic resonance imaging are superior to US in evaluation of the mediastinum, but US is a reasonable alternative in certain situations (eg, to avoid unnecessary investigation of a normal thymus simulating a mediastinal mass). In cases of chest wall lesions, US may enable localization of the site of origin to soft tissues or an extrapleural intrathoracic location. Osseous involvement, particularly rib involvement, is easily evaluated with US.     

肺弥散功能指标DLco、Kco在肺疾病诊断中应用价值的探讨

为了进一步了解各有关因素对肺弥散功能DLco及Kco测定的影响以及二者测定在航天医学中应用的可行性.本实验采用一口气法对120例健康人和76例肺疾病患者进行了肺弥散功能和常规肺功能测定,并作了对比分析.结果表明,健康人DLco、Kco均值随年龄增加而递减.DLco男性大于女性,与身高呈正相关,随肺容量(VC、TLC)增加而增加.Kco不受身高、性别及肺容量的影响,但随FEV_1的百分数增加而增加,随RV的百分数的增加而减少.在健康人中,虽然肺容量、通气量对DLco、Kco的影响有差异,但二者所占预计值的百分比基本相同.说明在健康人中二者的变化是同步的.在各种肺疾病中,二种指标均有下降.但在阻塞性肺疾病中以Kco反应敏感,可作为早期诊断肺气肿的指标.在限制性肺疾病中,以DLco下降更显著,说明在不同肺疾病中二者的反应是有差别的.这两项指标既有相关性,又各具特点.二者结合起来分析,对于航天医学中正确判断肺弥散障碍发生的环节,对于潜在性疾病的早期诊断和鉴别具有实用价值.     

肺部病变声像图特征研究与诊断

目的：探讨肺部肿瘤、非肿瘤的声像特征及其诊断价值。材料和方法：９０ 处肺部病变,对其超声征象特征进行前瞻性观察、研究,并与Ｘ 线、ＣＴ、病理结果进行比较研究。结果：１ 、归纳出肺部肿瘤、非肿瘤的声像图特征：团块征、分叶征、结节征、舌征、支气管充气征、森林一阳光征等十二个征象; ２ 、超声对肺部疾病诊断的准确率：８８ ．２ ％ ,对肿瘤诊断的敏感性９７ ．６７ ％ ,特异性６９ ．５７ ％ ,对非肿瘤诊断的敏感性８５ ．３ ％ ,特异性９３ ．４ ％ 。结论：１ 、超声诊断对肺部疾病的诊断与鉴别诊断有重要价值。２ 、Ｂ 超对ＣＴ、Ｘ 线诊断有不可忽视的补充和修正价值,联合诊断可大大提高诊断准确率（Ｐ＜ ０ ．０５ ～０ ．０１）     

Thoracic ultrasound: An adjunctive and valuable imaging tool in emergency,resource-limited settings and for a sustainable monitoring of patients

Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound (TUS) with conventional (chest X-rays-) and more advanced imaging procedures (computed tomography and magnetic resonance imaging) implies advantages, limitations and actual problems. Indeed, despite TUS may provide useful imaging of pleura, lung and heart disease, emergency scenarios are currently the most warranted field of application of TUS: Pleural effusion, pneumothorax, lung consolidation. This stems from its role in limited resources subsets; actually, ultrasound is an excellent risk reducing tool, which acts by: (1) increasing diagnostic certainty; (2) shortening time to definitive therapy; and (3) decreasing problems from blind procedures that carry an inherent level of complications. In addition, paediatric and newborn disease are particularly suitable for TUS investigation, aimed at the detection of congenital or acquired chest disease avoiding, limiting or postponing radiological exposure. TUS improves the effectiveness of elective medical practice, in resource-limited settings, in small point of care facilities and particularly in poorer countries. Quality and information provided by the procedure are increased avoiding whenever possible artefacts that can prevent or mislead the achievement of the correct diagnosis. Reliable monitoring of patients is possible, taking into consideration that appropriate expertise, knowledge, skills, training, and even adequate equipment’s suitability are not always and everywhere affordable or accessible. TUS is complementary imaging procedure for the radiologist and an excellent basic diagnostic tool suitable to be shared with pneumologists, cardiologists and emergency physicians.     

超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值

目的 评价超细支气管镜结合经皮肺穿技术在肺外周病变诊断中的价值.方法 269例肺外周病变患者均先进行超细支气管镜活检并刷检术,对无阳性结果,且病灶位于肺门、内带或中带的89例患者进行X线引导超细支气管镜肺活检并刷检术;对病灶位于中、外带的77例患者,经X线引导进行经皮肺穿刺针吸活检术;对于超细病灶紧贴胸壁的70例患者经B超引导进行经皮肺自动弹性穿刺切割活检术.结果 269例患者行超细支气管镜肺活检并刷检共276例次,获得诊断者82例,阳性率为30.5%(82/269);89例患者行X线引导超细支气管镜肺活检并刷检94例次,获得诊断者66例,阳性率为74.2%(66/89);77例患者行X线引导经皮肺针吸活检85例次,获得诊断者52例,阳性率为67.5%(52/77);70例患者行B超引导经皮肺自动弹性穿刺切割术79例次,获得诊断者49例,阳性率为70.0%(49/70).4种方法结合后的诊断率(92.6%)明显提高.结论 综合超细支气管镜检查结合经皮肺穿等介入诊断技术,可明显提高肺外周病变的阳性率,值得临床推广应用.     

Ultrasonographic localization of occult pulmonary nodules during video-assisted thoracic surgery

The aim of our study was to evaluate the role of ultrasonography in the localization of pulmonary nodules during video-assisted thoracic surgery (VATS). Ultrasonography was performed in 35 patients for the localization of pulmonary nodules during VATS. Indication for VATS was excisional biopsy of undetermined nodules in 22 patients, single or multiple metastasectomy in 12 patients and resection of primitive pulmonary cancer in 1 patient with reduced pulmonary reserve. A laparoscopic probe with flexible head and multi-frequency transducer (5–7.5 MHz) was used. Intraoperative ultrasonography localized 37 of 40 nodules preoperatively detected by CT and/or by positron emission tomography in 35 patients. Furthermore, ultrasonography localized two nodules not visualized at spiral CT. Eighteen nodules were not visible or palpable at thoracoscopic examination and were found by intraoperative sonography only. In 6 patients in whom thoracotomy was performed, manual palpation did not reveal more lesions than ultrasonography. In our experience, ultrasonography was very helpful when lesions were not visible or palpable during thoracoscopy, showing high sensitivity (92.5%) in finding pulmonary nodules. Since it is not possible to determine preoperatively whether a localization technique will be necessary during the operation or not, and ultrasonography is a non-invasive technique, we think that, at present, this technique can be considered as the first-instance localization technique during thoracoscopic resection of pulmonary nodules.     

Peripheral pulmonary diseases: evaluation with endobronchial US initial experience

Endobronchial ultrasonography (US) with 4.5-F small-caliber US probes, combined with bronchoalveolar lavage technique, was evaluated in autopsied lungs and 22 patients with various pulmonary interstitial or alveolar diseases. Several different echoic patterns were found that may reflect changes due to pathologic alteration of lung parenchyma. This technique may have potential for evaluation and diagnosis of peripheral lung diseases.     

肺真菌病临床影像学分析

目的：分析肺真菌病的临床影像表现,提高诊断水平。方法：回顾分析21例肺真菌病（穿刺/手术/支纤镜病理证实16例,痰培养及临床证实5例）的X线、CT表现。20例行胸部X线及CT检查,1例仅行胸片检查。结果：肺曲霉菌6例,肺隐球菌8例,肺念珠菌2例,肺毛霉菌3例,肺放线菌2例。左肺6例,右肺6例,双肺多发9例。多发病灶常位于胸膜下,且以两肺中下叶受侵最常见。呈单/多发结节或肿块/空洞10例;呈单/多发斑片影者4例;斑片与结节/空洞影混合者7例。晕征、新月征、洞中球征/滚珠征/悬球征/洞中丝征为本病较为特征性表现。结论：影像学表现典型者可做出诊断,疑似者应及时进一步检查,以免延误诊治。     

支气管血管束异常在肺弥漫性病变诊断中的价值

目的：探讨支气管血管束异常对于肺弥漫性病变的鉴别诊断价值。材料与方法：７２例肺弥漫性病变中，经病理证实１５例，其余５７例均经临床证实。其中肺弥漫性间质性病变３３例，肺弥漫性实质性病变５例，支气管病变１４例，播散性病变２０例。全部病例均做了胸部ＣＴ常规扫描，少数病例同时做了ＨＲＣＴ扫描，每例均由两位主任医师共同观察。结果：支气管血管束异常征象：（１）支气管血管束变细，主要见于肺弥漫性间质性病变和慢性支气管炎。（２）支气管血管束增粗，主要见于肺间质性病变及播散性病变，结节病与癌性淋巴管炎多呈串珠状增粗。（３）支气管血管束显示率增加，主要见于毛细支气管炎及播散性病变。结论：支气管血管束异常是肺弥漫性病变的ＣＴ征象，占８０％，支气管血管束异常无特异性，但呈串珠状增粗多见于结节病及癌性淋巴管炎。特发性肺间质纤维化及慢性支气管炎伴弥漫性间质性病变时，参考横膈位置具有鉴别诊断价值，前者横膈位置正常或升高，后者横膈位置低平。支气管血管束从正常演变到异常，表示病变的发展。     

膝关节及周围常见疾病的超声诊断研究

目的：探讨超声检查对膝关节及周围常见疾病的诊断价值。方法：运用超声对膝关节及周围常见疾病进行诊断。结果：对21例胭窝囊肿和20例胭窝脂肪瘤及ll例膝关节腔积液的超声检查结果与手术病例证实,符合率达100％;对74例膝关节共148个半月板超声检查结果与关节镜检查结果进行对照分析,结果148个半月板中,关节镜发现半月板损伤46个,超声检查准确做出半月板损伤诊断38个,漏诊8个,阴性97个,假阳性5个。超声诊断半月板损伤的准确率91．2％,敏感性82．6％,特异性95．1％,阳性结果预测值88．4％,阴性结果预测值92．4％。结论：超声检查无创、方便、诊断膝关节及周围疾病的准确性较高,可作为基层医院一种广泛开展的检查方法。     

Interstitielle Lungenerkrankungen (ILD) bei Rauchern

Smoking is a known risk factor for the development of various interstitial lung diseases, e.g. respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, desquamative interstitial pneumonia, and pulmonary Langerhans cell histiocytosis. These disorders frequently present with overlapping clinical pathological features and in addition may coexist within the same patient. In the clinical routine the differential diagnosis may be challenging or even impossible; therefore, smoking-related lung diseases are considered as part of the same disease spectrum representing different degrees of lung parenchymal damage secondary to cigarette smoke exposure. The role of cigarette smoking in the development of pulmonary fibrosis is complex and subject to intense investigation. It encompasses a subset of patients with nonspecific interstitial pneumonia where cigarette smoking may have played a causative role as well as patients with combined pulmonary fibrosis and emphysema (CPFE) as a novel entity with clearly defined clinical radiological features.     

肺性肥大性骨关节病的骨显像研究

目的 观察各种肺疾病肺性肥大性骨关节病（HPO）的发生率、治疗后HPO的消失率以及骨显像与X线诊断HPO的价值。方法 对703例各种肺疾患患者的骨显像作回顾性分析。显像剂为^99Tc^m-亚甲基二磷酸盐（MDP）。结果 （1）703例各种肺疾患患者HPO的发生率为7．4％,其中肺癌患者HPO发生率为7．6％。（2）41例肺癌经手术或化疗后HPO消失31例。（3）32例甲状腺癌和骨癌肺转移患者骨显像无1例发生HPO,但4例鼻咽癌肺转移患者3例为HPO。结论 （1）骨显像出现HPO图像可提示肺疾患的发生;（2）鼻咽癌肺转移HPO发生率较高,临床上鼻咽癌患者骨显像出现HPO表现可提示发生肺转移。     

Ecografía torácica de las infecciones víricas

Ultrasonography has proven useful in the study of many pulmonary diseases that affect the subpleural regions. This article reviews the current evidence regarding the role of ultrasonography in the diagnosis and management of viral lung infections. It describes the examination technique and the main ultrasonographic findings for different viruses that can affect the lungs.     

Lung ultrasound imaging in avian influenza A (H7N9) respiratory failure

Background

Lung ultrasound has been shown to identify in real-time, various pathologies of the lung such as pneumonia, viral pneumonia, and acute respiratory distress syndrome (ARDS). Lung ultrasound maybe a first-line alternative to chest X-ray and CT scan in critically ill patients with respiratory failure. We describe the use of lung ultrasound imaging and findings in two cases of severe respiratory failure from avian influenza A (H7N9) infection.

Methods

Serial lung ultrasound images and video from two cases of H7N9 respiratory failure requiring mechanical ventilation and extracorporeal membrane oxygenation in a tertiary care intensive care unit were analyzed for characteristic lung ultrasound findings described previously for respiratory failure and infection. These findings were followed serially, correlated with clinical course and chest X-ray.

Results

In both patients, characteristic lung ultrasound findings have been observed as previously described in viral pulmonary infections: subpleural consolidations associated or not with local pleural effusion. In addition, numerous, confluent, or coalescing B-lines leading to ‘white lung’ with corresponding pleural line thickening are associated with ARDS. Extension or reduction of lesions observed with ultrasound was also correlated respectively with clinical worsening or improvement. Coexisting consolidated pneumonia with sonographic air bronchograms was noted in one patient who did not survive.

Conclusions

Clinicians with access to point-of-care ultrasonography may use these findings as an alternative to chest X-ray or CT scan. Lung ultrasound imaging may assist in the efficient allocation of intensive care for patients with respiratory failure from viral pulmonary infections, especially in resource scarce settings or situations such as future respiratory virus outbreaks or pandemics.     

微创电视胸腔镜手术临床研究

目的 探讨微创电视胸腔镜手术（VATS）在胸外科诊疗中的应用，重点研究胸外伤VATS的适应证、手术操作和并发症、方法 总结1995年1月-2005年1月应用胸腔镜辅助手术治疗324例，主要病种包括胸外伤205例，自发性气胸43例，肺肿瘤32例，纵隔肿瘤或囊肿22例，以及巨型肺大疱、恶性胸腔积液、心包积液、脓胸等22例。结果 平均手术时间56min，平均术后住院时间7d，手术效果满意，中转开胸完成手术25例（7．7％），非致命性手术并发症32例（9．9％），手术后死亡5例，无术中死亡。主要并发症为肺漏气、呼吸道感染、肺不张、复张性肺水肿、出血等。结论 VATS及辅助小切口治疗具有创伤小、恢复快、安全可靠等优点，使胸外伤患者得到更及时的手术机会，对胸外伤、自发性气胸、肺周围型肿块或结节、纵隔良性肿瘤、早期肺癌、恶性胸腔积液、纤维素期脓胸等有良好的治疗效果。熟练掌握VATS技术能减少手中及术后并发症。     

乳腺X线导管造影和染色定位对乳腺疾病的临床价值探讨

目的:探讨乳腺X线导管造影和染色定位的操作摄影技术要求及其X线特征。方法:回顾分析经手术切除和穿刺活检病理证实的60例乳腺疾病的乳腺导管造影和染色定位资料。结果:本组3例穿刺失败,57例导管造影成功,53例导管造影的影像诊断与手术及穿刺活检证实的结果相同。肿瘤性病变10例,非肿瘤性病变47例。38例术前行染色定位,术中使得病灶形态显示更为全面和直观。结论:导管造影和染色定位可对乳腺疾病的诊断、临床术前术中评估及手术方案的制订提供更全面、更有价值的信息。     

Pulmonary hypertension: the contribution of MDCT to the diagnosis of its different types

Pulmonary hypertension is characterized by progressive involvement of the pulmonary vessels that leads to increased vascular resistance and consequently to right ventricular failure. Vascular lesions are a common factor in a wide spectrum of diseases, and their result, pulmonary hypertension, is a severe clinical condition with a poor prognosis that worsens the normal course of the diseases to which it is associated (COPD, collagen disease, sarcoidosis, and congenital or acquired heart disease). It is important for pulmonary hypertension to be diagnosed as early as possible because nowadays drugs can reduce mortality and improve the quality of life; furthermore, some types of pulmonary hypertension (e.g., chronic thromboembolism and those associated with some congenital heart diseases like left-to-right shunt) can be treated surgically. In cases of suspected pulmonary hypertension, imaging methods can confirm the diagnosis, suggest a cause, help choose the most appropriate treatment, and monitor the response to treatment. This review describes the approach to pulmonary hypertension using different imaging techniques; special emphasis is given to the role of multidetector CT (MDCT), which makes it possible to study all the organs in the thorax in a single acquisition. We review the radiological signs of pulmonary hypertension and the current (Dana Point) radiological criteria for classifying the type of hypertension based on alterations in the lung parenchyma, mediastinum, pleural spaces, and pericardium, as well as on the study of the chambers of the heart.     

肺错构瘤的CT表现及其与其他疾病的鉴别

目的分析肺错构瘤的MSCT表现及其与其他疾病的鉴别。方法对26例行MSCT检查并经手术和病理证实的肺错构瘤进行回顾性分析。结果本组26例均为单发肺错构瘤,其中22例为周围型,位于右肺12例,位于左肺10例;4例为腔内型,其中,1例位于气管中段腔内,1例位于左主支气管内,2例位于左肺下叶支气管内。病灶呈圆形或椭圆形,边缘锐利,9例显示有浅分叶,但均无毛刺。本组22例周围型错构瘤中,3例病灶内含有脂肪密度影;9例病灶内含有钙化影,其中3例为典型的爆米花样钙化;10例病灶呈均匀软组织密度影。4例腔内型错构瘤中,3例病灶内含有脂肪成分,1例含有钙化影。本病主要需于肺炎性假瘤、小叶癌、结核瘤相鉴别。结论肺错构瘤的MSCT表现有一定特征,病灶边缘清楚,内含有脂肪和钙化有助于正确诊断。     

28例飞行人员胸外科疾病的诊治及医学鉴定

目的探讨飞行人员胸外科疾病的诊治及医学鉴定原则。方法收集分析我院近20年收治的28例胸外科疾病飞行人员的临床诊治经过及最终医学鉴定结论资料,对不同疾病种类、有无临床症状、飞行结论、机种以及合格飞行人员的随访进行统计分析。结果有50％的患者无临床症状,系在体检过程中胸部X线检查发现。有、无临床症状与疾病的性质及鉴定结论间无相关性。恶性疾病9例,占32．1％,其中肺癌常见;非恶性疾病中,先天性疾病、感染性疾病及原发性气胸常见。28例胸外科疾病飞行人员治疗后飞行合格率较高,为60．7％。合格飞行人员随访至今或最高年限,疾病未再发,空中适应良好。结论飞行人员罹患胸外科疾病相对较少,年度大体检特别是胸部X线片检查对疾病早期诊断有重要价值。肺癌早期经积极治疗,肺功能良好者可恢复飞行。胸外科微创治疗有利于恢复飞行。原发性气胸及肺大泡的医学鉴定应注意复发率的评估。重视肺内孤立结节的鉴别诊断。