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Correspondence |

Relevance of Subpleural Consolidations in Chest Ultrasound FREE TO VIEW

Angelika Reissig, MD; Claus Kroegel, MD, PhD, FCCP
Author and Funding Information

Affiliations: Drs. Reissig and Kroegel are affiliated with Friedrich-Schiller University Jena.

Correspondence to: Angelika Reissig, MD, Friedrich-Schiller University Jena, Innere Medizin, Pneumology and Allergology, Medical Clinic I, Erlanger Allee 101, Jena 07740, Germany.


Financial/nonfinancial disclosures: The authors have reported to the ACCP that no significant 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).


© 2009 American College of Chest Physicians


Chest. 2009;136(6):1706. doi:10.1378/chest.08-2541
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To the Editor:

In their article in a recent issue of CHEST (July 2008) entitled “Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure,” Lichtenstein and Mezière1 described the sonographic diagnosis of patients with acute respiratory failure admitted to the ICU. In principal, their approach of applying diagnostic profiles for the diagnosis of pulmonary diseases is interesting. However, the conclusions drawn from their data are incorrect. In fact, various investigations have demonstrated rather specific pulmonary abnormalities associated with certain lung conditions, which have been completely omitted by Lichtenstein and Mezière.1

For instance, the authors claimed that patients with predominant A lines (indicating normal lung surface) and venous thrombosis certify a diagnosis of pulmonary embolism (PE). Venous thrombosis, in turn, precedes or is often associated with PE, which may be detected as sharply demarked hypodense lesions (Fig 1). Moreover, a normal lung surface not only indicates asthma or COPD but also may show no lung disease, or, in a few cases, strictly central localized PE or pneumonia.

Figure Jump LinkFigure 1 Sonogram of parenchymal alterations associated with PE in a 50-year old woman with inserting dyspnea. Two triangular, hypoechoic, pleural-based parenchymal lesions are seen; the right one contains a single centrally located echo.Grahic Jump Location

Lichtenstein and Mezière1 completely disregarded the findings described by a number of publications including a multicenter study.2,3 In addition, the conclusions based on their ultrasound investigation may be drawn from clinical findings alone and do not necessarily require ultrasound examination of the lung. Therefore, the specificity and sensitivity calculated on the bases of their data are questionable. In conclusion, although interesting, the conclusions drawn by Lichtenstein and Mezière1 are not substantiated by the data presented.

Lichtenstein D, Mezière G. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134:117-125. [PubMed] [CrossRef]
 
Reissig A, Heyne J-P, Kroegel C. Sonography of lung and pleura in pulmonary embolism: sonomorphologic characterization and comparison with spiral CT scanning. Chest. 2001;120:1977-1983. [PubMed]
 
Mathis G, Blank W, Reissig A, et al. Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients. Chest. 2005;128:1531-1538. [PubMed]
 

Figures

Figure Jump LinkFigure 1 Sonogram of parenchymal alterations associated with PE in a 50-year old woman with inserting dyspnea. Two triangular, hypoechoic, pleural-based parenchymal lesions are seen; the right one contains a single centrally located echo.Grahic Jump Location

Tables

References

Lichtenstein D, Mezière G. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134:117-125. [PubMed] [CrossRef]
 
Reissig A, Heyne J-P, Kroegel C. Sonography of lung and pleura in pulmonary embolism: sonomorphologic characterization and comparison with spiral CT scanning. Chest. 2001;120:1977-1983. [PubMed]
 
Mathis G, Blank W, Reissig A, et al. Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients. Chest. 2005;128:1531-1538. [PubMed]
 
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