Imaging |

Ultrasonographic Evaluation of the Thorax in Lung Transplant Recipients Undergoing Transbronchial Lung Biopsies FREE TO VIEW

Killol Patel, MBBS; Irtza Sharif; Nelson Medina Villanueva; Navneet Arora; Chaitali Gupte; Evgeny Pinelis; Pratik Patel; Keith Guevarra
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Newark Beth Israel Medical Center, Newark, NJ

Chest. 2014;146(4_MeetingAbstracts):576A. doi:10.1378/chest.1988175
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SESSION TITLE: Ultrasound and Other Imaging Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Advances in ultrasonagraphy techniques and availability over the last decade have allowed its use to aid physicians across a growing spectrum of cases as is evident in the growing volumes of literature showing its utility. One of the areas of emerging importance is for the evaluation of potential pneumothoraces. The body of literature for this is large and compelling, but one of the limitations of ultrasound is that it is dependent on the motion of pleura independent of the thoracic wall. This might be a concern in transplant patients as the donor lung is only in approximate size and shape as the native lung and might not behave in the same manner. Our study is to evaluate the utility of ultrasound to rule out pneumothorax in the setting of lung biopsies done post lung transplant.

METHODS: Lung transplant recipients undergoing surveillance bronchoscopy with transbronchial biopsies were enrolled in the study in sequence in an unblinded fashion. Ultrasound of the chest was performed by pulmonary fellows under direct supervision of a trained attending physician. Each patient had ultrasound evaluation done at the apex, T4 level, lateral thorax and the diaphragmatic angle looking for lung sliding and lung point both before and after the procedure. Findings were correlated with post procedure chest X-ray.

RESULTS: 10 patients were enrolled in the study with 80 individual points on the chest wall evaulated. There was no point on the chest wall in which lung sliding was present in all patients. Overall, lung sliding was present in 58/60 points (72.5%) confidence interval (CI) [61.4%-81.9%] and lung pulse was seen in 66/80 points(82.5%) CI [72.4%-90.1%]. There is no statistical difference between lung point and lung sliding (p=0.18).

CONCLUSIONS: From this small cohort, we were able to demonstrate that the history of transplant likely limits the utility of ultrasound in the evaluation of pneumothorax in at least some patients. Given that there has not been a treated pneumothorax in this cohort, it is yet to be determined if the development of pneumothorax will change the pre to post procedure examination.However, we found that the donor lung does not demonstrate similar ultrasound findings as a native lung would.

CLINICAL IMPLICATIONS: Bedside Ultrasonography findings after lung transplant are different than what would be routinely expected of patients with native lungs and it can not be reliably used to rule out pneumothorax after surveillance trans bronchial biopsies in transplant patients.

DISCLOSURE: The following authors have nothing to disclose: Killol Patel, Irtza Sharif, Nelson Medina Villanueva, Navneet Arora, Chaitali Gupte, Evgeny Pinelis, Pratik Patel, Keith Guevarra

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