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【medical-news】Chest physicians promote ultrasound for det
11/22/2006
By: Edward Susman
http://www.auntminnie.com/index.asp?Sec=sup&Sub=ult&Pag=dis&ItemId=73630
Ultrasonography can easily detect various pulmonary conditions with a high degree of accuracy, despite previous reports to the contrary, according to presenters at the Chest 2006 meeting in Salt Lake City.
"We have been told, even very recently, that the lungs are off-limits to ultrasound," said Dr. Daniel Lichtenstein, director of the medical intensive care unit at the Hospital Ambroise Par?in Boulogne, France. "But lung ultrasonography is really a simple matter," he added, speaking at a symposium on pleural ultrasound at the meeting, which was organized by the American College of Chest Physicians.
Rather than offering just a structural view, ultrasound takes advantage of certain phenomenology in the lungs to produce certain unmistakable images that tell a definitive story of what is happening in the lungs, Lichtenstein said. In addition, using ultrasound could limit the number of CT or x-ray exams that a patient undergoes, thereby reducing the exposure to radiation, he said.
"Using very simple signs, we will be able to describe most of the acute situations," he said. Lichtenstein outlined some of the critical and easily recognizable signs in lung sonography:
The "Bat" sign (as in the Batman) provides the landmarks for the location of the ribs and the lungs.
The "A" sign appears as a horizontal line across the monitor. These lines occur in a descending pattern equidistant from each other.
The "B" sign has laser-like rays descending from the pleural line. This sign resembles one of the alien-structures that Tom Cruise battled in the movie, "War of the Worlds."
The presence or absence of these signs can aid clinicians in diagnosing thoracentesis, detecting pneumothorax, and distinguishing pulmonary edema from chronic obstructive pulmonary disease, pulmonary embolisms, and other conditions, Lichtenstein said.
In another talk, Dr. Peter Doelken urged his fellow chest specialists to become experts in pulmonary ultrasonography -- something that can be achieved in a very short time, he added. Doelken is an assistant professor of medicine at the Medical University of South Carolina in Charleston and served as the symposium's chairman.
A strength of ultrasound is its ability to detect pleural fluid and even determine the composition of that fluid, Doelken said.
However, ultrasound does have its pitfalls, he stressed, including a misreading of the organs. Doelken advised the first thing a clinician should do when performing a sonographic exam is to find the kidneys and liver, then go on to locate the diaphragm.
In another talk, Dr. Paul Mayo suggested that once pleural effusions are identified, ultrasound can help the clinician gain access to those effusions. Mayo is the director of the medical intensive care unit at Beth Israel Medical Center and a professor of medicine at Albert Einstein College of Medicine, both in New York City.
Mayo laid out three cardinal rules for sonographic identification of pleural effusion:
Is there an identifiable, echo-free space?
Have the typical anatomical boundaries been defined and located?
Are there typical dynamic changes?
The important anatomical boundaries are the diaphragm, the chest wall, and the location of the lungs, he said, adding that the location of the diaphragm can differ among patients. For example, the diaphragm in patients who have undergone coronary bypass graft surgery can be "extraordinarily high," he noted. Mayo said that he has seen serious complications when the clinician misread the position of the diaphragm and pierced the liver, instead of the lungs, to remove fluid.
Neophyte pulmonary ultrasonographers should concentrate on finding "great big black pleural effusions" for at least their first 50 cases, Mayo said. After becoming more comfortable with ultrasound, "you will start to find those gray pleural effusions and, after having done 100 of them, you can chase after the pleural effusions that no one else can see," he added.
By Edward Susman
AuntMinnie.com contributing writer 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Chest physicians promote ultrasound for detecting pleural anomalies
胸科医生提倡超声检查胸膜异常
根据作者在2006年盐湖城胸科会议的报告,尽管先前报告的结果相反,但超声波检查能容易高度准确地检测肺的各种各样的情况
”甚至最近,有人告诉我肺对超声波来说是禁区”, Dr. Daniel Lichtenstein, 在法国Boulogne Ambroise Par医院内科重症监护病房主任说,”但是肺超声波检查真的是一件简单的事情”,这是他在美国胸内科医师学会组织的胸膜超声会议上说.
超声不是提供一个结构图,而是利用肺部的某种现象学产生某种明白的影象,这可确定肺部的问题. Lichtenstein说, 还有,应用超声波检查可以限定CT 或X线检查,因此减少患者摄入射线
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作者:admin@医学,生命科学 2011-05-06 17:11
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