Imaging |

M-Mode Ultrasound to Define Pleural and Subpleural Morphology Among Patients With Interstitial Lung Syndromes FREE TO VIEW

Anup Singh, MD; Stella Hahn, MD; Atul Palkar, MD; Asma Iftikhar, MD; Arunabh Talwar, MD; Seth Koenig, MD; Mangala Narasimhan, DO; Paul Mayo, MD
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Hofstra Northshore LIJ School of Medicine, Manhasset, NY

Chest. 2015;148(4_MeetingAbstracts):504A. doi:10.1378/chest.2280801
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SESSION TITLE: Imaging Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Interstitial lung syndrome is caused by cardiogenic pulmonary edema, pulmonary fibrosis or interstitial pneumonia. Presence of multiple diffuse bilateral “B line” pattern on lung ultrasound indicates interstitial syndrome, but differentiating between individual etiologies can be challenging. M-mode ultrasonography may be helpful to evaluate interstitial lung syndromes. We conducted this study to identify whether M- mode ultrasonography can be used to differentiate interstitial lung syndromes.

METHODS: M-mode ultrasonography of the pleural surface was performed by a single operator on 35 patients by examining 4 symmetrical chest areas on each side with the patient in supine position. Three groups of patients were evaluated: pulmonary fibrosis/interstitial pneumonia (PIF), cardiogenic pulmonary edema (CPE), and control group (no known interstitial syndrome). Data was interpreted to identify M mode patterns.

RESULTS: Thirteen patients in the PIF group and 10 subjects in the other two groups met inclusion and exclusion criteria. Three pleural morphology patterns were recognized: continuous, irregular and fragmented pleura. Two sub-pleural patterns were recognized: vertical and horizontal. PIF, CPE and control group had “fragmented pleural line” in 60/91 (65.9%), 9/71 (12.6%) and 1/72 (1.3%) of scanned areas, respectively (p< 0.00001). PIF, CPE, and control group had “vertical sub-pleural pattern” in 87/90 (96.6%), 49/72 (68.05%) and 5/66 (7.57%) of scanned areas respectively (p< 0.00001). PIF group had 9 patients with pulmonary fibrosis, 1 with non-specific interstitial pneumonitis (NSIP) and, 3 with interstitial pneumonitis. 38/59 (64.4%), 1/8 (12.5%), and 21/24 (87.5%) of scanned areas among patients with pulmonary fibrosis, NSIP and interstitial pneumonitis has “fragmented pleural line”, respectively. All three patients with pleural effusion had “irregular pleural” pattern at inferior axillary area.

CONCLUSIONS: This is the first study to use M-mode ultrasonography to characterize pleural and sub-pleural morphology for differentiating etiologies of interstitial lung syndrome. PIF group is characterized by fragmented pleura and vertical sub-pleural pattern, whereas continuous pleural and vertical sub-pleural pattern is characteristic of CPE group. Control group had continuous pleural and horizontal sub-pleural pattern.

CLINICAL IMPLICATIONS: M-mode ultrasonography may be able to differentiate CPE from other interstitial pattern. This study suggests need for further large scale study to confirm our results.

DISCLOSURE: The following authors have nothing to disclose: Anup Singh, Stella Hahn, Atul Palkar, Asma Iftikhar, Arunabh Talwar, Seth Koenig, Mangala Narasimhan, Paul Mayo

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