Medical Students Are Accurate in Interpreting the Presence of Pathologic Interstitial Edema on Focused Lung Ultrasound Compared to Expert Reviewers

Abstract Background: The role of lung ultrasound has never been evaluated in parturients with severe preeclampsia. The authors’ first aim was to assess the ability of lung ultrasound to detect pulmonary edema in severe preeclampsia. The second aim was to highlight the relation between B-lines and increased left ventricular end-diastolic pressures. Methods: This prospective cohort study was conducted in a level-3 maternity during a 12-month period. Twenty parturients with severe preeclampsia were consecutively enrolled. Both lung and cardiac ultrasound examinations were performed before (n = 20) and after delivery (n = 20). Each parturient with severe preeclampsia was compared with a control healthy parturient. Pulmonary edema was determined using two scores: the B-pattern and the Echo Comet Score. Left ventricular end-diastolic pressures were assessed by transthoracic echocardiography. Results: Lung ultrasound detected interstitial edema in five parturients (25%) with severe preeclampsia. A B-pattern was associated to increased mitral valve early diastolic peak E (116 vs. 90 cm/s; P = 0.05) and to increased E/E’ ratio (9.9 vs. 6.6; P < 0.001). An Echo Comet Score of greater than 25 predicted an increase in filling pressures (E/E’ ratio >9.5) with a sensitivity and specificity of 1.00 (95% CI, 0.69 to 1.00) and 0.82 (95% CI, 0.66 to 0.92), respectively. Conclusions: In parturients with severe preeclampsia, lung ultrasound detects both pulmonary edema and increased left ventricular end-diastolic pressures. The finding of a B-pattern should restrict the use of fluid. However, these preliminary results are associations from a single sample. They need to be replicated in a larger, definitive study.

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P817 Lung ultrasound in the evaluation of pulmonary congestion in patients with aortic stenosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.469 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I Szabo ◽

L Gargani ◽

B Illes ◽

A Frigy ◽

A Varga ◽

...

Keyword(s):

Aortic Stenosis ◽

Functional Status ◽

Lung Ultrasound ◽

Severe Aortic Stenosis ◽

Left Ventricular ◽

Volume Index ◽

Pulmonary Congestion ◽

Interstitial Edema ◽

Severe Aortic Regurgitation ◽

B Lines

Abstract Background Aortic stenosis (AS) has a prolonged latent period, as AS worsens, the left ventricular adaptations become inadequate and impaired systolic and/or diastolic dysfunction, may lead to clinical heart failure (HF). The development of HF is an inflexion point in the natural history of AS. Pulmonary congestion is a nearly universal pathophysiological finding in HF, and may precede symptoms. Lung ultrasound (LUS) evaluation of B-lines has been proposed as a simple, non-invasive tool to assess pulmonary interstitial edema. Aim To assess pulmonary interstitial edema with LUS in patients with moderate and severe aortic stenosis, to define performance of LUS compared with clinical assessment and echocardiographic parameters. Methods Sixty-eight consecutive patients (36 women, mean age 74 ± 9 years) with moderate or severe aortic stenosis were enrolled. Exclusion criteria were as follows: moderate or severe aortic regurgitation, moderate or severe mitral regurgitation, cardiomyopathies and pulmonary disease. All patients underwent comprehensive echocardiography examination and LUS according to a previously validated 28 scanning-site assessment. Results we found a significant number of B-lines (≥15) in 79% of patients. B-lines were positively correlated with left atrial volume index (p < 0,05, r = 0,3) and estimated pulmonary pressure ( p < 0,0001, r= 0,62 Figure 1.) The number of B-lines didn’t correlate with the severity of AS (mean gradient vs. B-lines: p = 0,2, valve area vs. B-lines: p = 0,2.), however properly reflects different functional status of the patients (p < 0,0001, Figure 2.) Conclusion Lung ultrasound is a promising tool to detect lung congestion related to AS. The severity of congestion doesn’t correlate with the severity of AS, albeit B-lines better reflect the deteriorating functional status of the patients and the haemodynamic consequences related to AS. Abstract P817 Figure. Correlation PASP vs Blines, NYHA/B-lines

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Accuracy of Medical Students in Detecting Pleural Effusion Using Lung Ultrasound as an Adjunct to the Physical Examination

Journal of Ultrasound in Medicine ◽

10.1002/jum.14612 ◽

2018 ◽

Vol 37 (11) ◽

pp. 2545-2552 ◽

Cited By ~ 4

Author(s):

Peter Steinmetz ◽

Sharon Oleskevich ◽

Alina Dyachenko ◽

Jane McCusker ◽

John Lewis

Keyword(s):

Medical Students ◽

Pleural Effusion ◽

Physical Examination ◽

Lung Ultrasound

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Limited Education of Lung Ultrasound Conducted to Medical Students: A Pilot Study

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2017.08.1226 ◽

2017 ◽

Vol 43 ◽

pp. S86

Author(s):

Sang Hun Lee ◽

Jang Sun Lim ◽

Han Ho Do ◽

Kyu Ho Oh

Keyword(s):

Medical Students ◽

Pilot Study ◽

Lung Ultrasound

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Ultrastructure of pulmonary microvasculature in acute endotoxemia

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100083217 ◽

1978 ◽

Vol 36 (2) ◽

pp. 470-471

Author(s):

R. G. Gerrity ◽

M. Richardson

Keyword(s):

Polymorphonuclear Leukocytes ◽

Alveolar Epithelium ◽

Endothelial Damage ◽

Capillary Endothelium ◽

Type Ii Cells ◽

Type Ii ◽

Interstitial Edema ◽

Pulmonary Capillaries ◽

Lung Ultrastructure ◽

Fibrin Thrombi

Dogs were injected intravenously with E_. coli endotoxin (2 mg/kg), and lung samples were taken at 15 min., 1 hr. and 24 hrs. At 15 min., occlusion of pulmonary capillaries by degranulating platelets and polymorphonuclear leukocytes (PML) was evident (Fig. 1). Capillary endothelium was intact but endothelial damage in small arteries and arterioles, accompanied by intraalveolar hemorrhage, was frequent (Fig. 2). Sloughing of the surfactant layer from alveolar epithelium was evident (Fig. 1). At 1 hr., platelet-PML plugs were no longer seen in capillaries, the endothelium of which was often vacuolated (Fig. 3). Interstitial edema and destruction of alveolar epithelium were seen, and type II cells had discharged their granules into the alveoli (Fig. 4). At 24 hr. phagocytic PML's were frequent in peripheral alveoli, while centrally, alveoli and vessels were packed with fibrin thrombi and PML's (Fig. 5). In similar dogs rendered thrombocytopenic with anti-platelet serum, lung ultrastructure was similar to that of controls, although PML's were more frequently seen in capillaries in the former (Fig. 6).

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