Ultrasound lung comets: A clinically useful sign of extravascular lung water
Ultrasound lung comets: A clinically useful sign of extravascular lung water
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DOI：
10.1016/j.echo.2005.05.019
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发表时间：
2006-03-01
影响因子：
6.5
通讯作者：
Mottola, G
中科院分区：
文献类型：
--
作者：
Picano, E;Frassi, F;Mottola, G
评估血管外肺水对临床心脏病医生来说是一项具有挑战性的任务，也是超声心动图医生难以捉摸的目标。今天，胸部X光被认为是客观评估血管外肺水的最佳方法，但这需要放射设备和特定的阅读专业知识，使用电离能量，并造成重大的后勤负担。最近，一种新的方法被开发使用超声心动图(带有心脏探头)的肺。血管外肺水的增加--通过胸部计算机断层扫描、胸部X光和热稀释技术独立评估--反映在超声肺彗星(ULCs)的出现上。ULCs由多个彗星尾巴组成，这些彗尾起源于水增厚的小叶间隔，并从肺表面呈扇形展开。这项技术需要对右胸前和左胸前，从第二肋间到第五肋间进行超声扫描。它很简单(学习曲线需要10次考试)，执行起来也很快(需要<；3分钟)。ULC评估是独立于心脏声学窗口的，因为胸前的肺是扫描的。它需要非常基本的2-D技术成像，即使没有二次谐波或多普勒。ULCs可能代表了一种相当于放射学Kerley B线的超声。在静态评估中，心源性水状彗星与肺源性纤维化彗星可能很难区分，尽管后者通常更局限于局部，且不会因急性利尿剂刺激而溶解。从功能上讲，ULCs是肺泡毛细血管膜受压的征象，通常伴随射血分数降低和肺楔压升高。ULC征象是定量的、可重复性的，非常适合作为常规超声心动图的补充，用于急诊科心力衰竭患者的评估(用于呼吸困难的鉴别诊断)、院内评估(用于定制利尿剂治疗)、家庭护理(使用便携式超声波)和负荷超声心动图实验室(作为应激期间急性肺充血的标志)。总之，ULCS是一种有用、实用且简单的直接成像血管外肺水的方法。
Assessment of extravascular lung water is a challenging task for the clinical cardiologist and an elusive target for the echocardiographer. Today chest x-ray is considered the best way to assess extravascular lung water objectively, but this requires radiology facilities and specific reading expertise, uses ionizing energy, and poses a significant logistic burden. Recently, a new method was developed using echocardiography (with cardiac probes) of the lung. An increase in extravascular lung water-as assessed independently by chest computed tomography, chest x-ray, and thermodilution techniques-is mirrored by appearance of ultrasound lung comets (ULCs). ULCs consist of multiple comet tails originating from water-thickened interlobular septa and fanning out from the lung surface. The technique requires ultrasound scanning of the anterior right and left chest, from the second to the fifth intercostal space. It is simple (with a learning curve of < 10 examinations) and fast to perform (requiring < 3 minutes). ULC assessment is independent of the cardiac acoustic window, because the lung on the anterior chest is scanned. It requires very basic 2-D technology imaging, even without a second harmonic or Doppler. ULCs probably represent an ultrasonic equivalent of radiologic Kerley B-lines. On still-frame assessment, cardiogenic watery comets can be difficult to distinguish from pneumogenic fibrotic comets, although the latter are usually more localized and are not dissolved by an acute diuretic challenge. Functionally, ULCs are a sign of distress of the alveolar-capillary membrane, often associated with reduced ejection fraction and increased pulmonary wedge pressure. The ULC sign is quantitative, reproducible, and ideally suited to complement conventional echocardiography in the evaluation of heart failure patients in the emergency department (for the differential diagnosis of dyspnea), in-hospital evaluation (for tailoring diuretic therapy), home care (with portable ultrasound), and stress echocardiography lab (as a sign of acute pulmonary congestion during stress). in conclusion, ULCs represent a useful, practical, and appealingly simple way to image directly extravascular lung water.