Anesth Pain Med.  2019 Jan;14(1):1-7. 10.17085/apm.2019.14.1.1.

Lung ultrasonography for thoracic surgery

• Ahn HJ

• KMID: 2434192
• DOI: http://doi.org/10.17085/apm.2019.14.1.1

Abstract

Patients undergoing thoracic surgery show various lesions such as chronic obstructive lung diseases, pleural adhesion, pneumonia, acute respiratory distress syndrome, atelectasis, pleural effusion, pulmonary edema, and pneumothorax throughout preoperative, operative, and recovery periods. Therefore, lung ultrasonography has potential for perioperative use in thoracic surgery. Benefits of lung ultrasonography over conventional chest X-ray are convincing. First, ultrasonography has higher sensitivity than X-ray in various lesions. Second, it can be performed at bed side to obtain diagnosis immediately. Third, it does not expose patients to radiologic hazard. If anesthesiologists can obtain necessary skills and perform lung ultrasonography as a routine evaluation process for patients, territory of anesthesia would become broader and patients would obtain more benefit.

Keyword

Pneumothorax; Pulmonary atelectasis; Thoracic surgery; Ultrasonography

MeSH Terms

Anesthesia
Diagnosis
Humans
Lung Diseases, Obstructive
Lung*
Pleural Effusion
Pneumonia
Pneumothorax
Pulmonary Atelectasis
Pulmonary Edema
Respiratory Distress Syndrome, Adult
Thoracic Surgery*
Thorax
Ultrasonography*

Figure

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  Fig. 1 Position of transducer, Lichtenstein method. PLAPS: posterolateral alveolar and/or pleural syndrome.

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  Fig. 2 BAT sign and A line.

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  Fig. 3 B line found in pulmonary edema.

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  Fig. 4 Seashore sign (left) and barcode sign (right) by M mode.

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  Fig. 5 Subpleural consolidations are usually less than 1 cm lesions under the pleura. It’s also called C line (arrow).

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  Fig. 6 Large consolidation (box). Normal lung tissue is seen on the left side (A line exist, arrow).

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  Fig. 7 Various signs shown in consolidation.

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  Fig. 8 Pleural effusion. Hyperechoic pleura and atelectactic lung tissue (tissue like change + shred sign) are seen under the effusion.

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  Fig. 9 Sine wave of pleural effusion by M mode.

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  Fig. 10 Transducer position for diaphragm excursion measurement. (A) For the right side, the transducer is positioned below the right costal margin between the midclavicular and anterior axillary lines. For the left side, the transducer is positioned at a left low intercostal or below the subcostal margin between the midclavicular and anterior axillary lines. (B) The probe angle: the ultrasound beam reached perpendicularly the posterior part of the diaphragm.

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