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Correspondence |

Why Look for Artifacts Alone When the Original Is Visible? FREE TO VIEW

Gebhard Mathis, MD
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From Internal Medicine Praxis.

Correspondence to: Gebhard Mathis, MD, Internal Medicine Praxis, Bahnhofstraβe 16, AT-6830 Rankweil, Austria ; e-mail: gebhard.mathis@cable.vol.at


Financial/nonfinancial disclosures: The authors has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):233. doi:10.1378/chest.08-2601
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To the Editor:

The study concerning the relevance of lung ultrasound in the diagnosis of acute respiratory failure by Lichtenstein and Mezière in CHEST (July 2008)1 raises a few basic questions. First of all, there is a technical problem: modern ultrasound systems work on the basis of noise reduction. As a result, one sees fewer artifacts.

Artifacts are a fundamental component of ultrasound imaging, for instance, the sonic shadow in the case of gallstones. However, the value of the method lies in its visualization of parenchyma, for instance, that of the liver. On chest ultrasonography, the presence of artifacts permits the diagnostician to confirm or rule out a pneumothorax (the absence of gliding, a large number of horizontal reverberations, and lung point) with a high accuracy. However, comet tails are found in a large number of interstitial lung processes, ranging from lung edema of various causes to fibrosis. One sees that the lung is diseased, but the spectrum of the etiologic characteristics of disease is very wide.

Second, one should not confine oneself to alveolar consolidations. It is a well-known fact that subpleural consolidations can be differentiated on the simple ultrasound B-mode image. Pneumonias can be directly visualized with a sensitivity of 90% and lung embolisms with an accuracy of 80%.2,3 Why select the anterior access alone when the largest portions of the lung are seen by the dorsal access? Why look for artifacts alone when the original is visible?

Referring to horizontal and vertical reverberations as A and B lines by way of terminology may well be meaningful for teaching purposes. However, further abbreviations would make the decision trees unnecessarily complex in terms of thought and action.

Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;1341:117-125. [CrossRef] [PubMed]
 
Yang PC, Luh KT, Chang DB, Yu CJ, Kuo SH, Wu HD. Ultrasonographic evaluation of pulmonary consolidation. Am Rev Respir Dis. 1992;1463:757-762. [PubMed]
 
Mathis G, Blank W, Reissig A, et al. Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients. Chest. 2005;1283:1531-1538. [CrossRef] [PubMed]
 

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References

Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;1341:117-125. [CrossRef] [PubMed]
 
Yang PC, Luh KT, Chang DB, Yu CJ, Kuo SH, Wu HD. Ultrasonographic evaluation of pulmonary consolidation. Am Rev Respir Dis. 1992;1463:757-762. [PubMed]
 
Mathis G, Blank W, Reissig A, et al. Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients. Chest. 2005;1283:1531-1538. [CrossRef] [PubMed]
 
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