Pleural ultrasound: What you need to know

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor II Khong Tien Dat, Doctor of Radiology - Department of Diagnostic Imaging - Vinmec Ha Long International General Hospital. The doctor has more than 14 years of experience in the field of diagnostic imaging.
pleural ultrasound is an imaging method aimed at diagnosing diseases in the chest wall such as pleural effusion, pleural tumor or pneumothorax. This method has many advantages and brings convenience and speed to clinicians in the diagnostic process.

1. What is pleural ultrasound?

pleural ultrasound is an imaging method to help evaluate the amount of pleural fluid in terms of quantity, nature as well as lesions in many different forms. In addition, pleural ultrasound is also used for early diagnosis of pneumothorax when X-ray cannot be taken. Today, pleural ultrasound is widely used thanks to the following advantages:
No irradiation dose Compact device Can be performed at the hospital bed, repeated many times Fast examination time Low cost
However, pleural ultrasound also has disadvantages that need to be noted such as:
Image quality depends on the nature of the equipment performed. Imaging-based diagnosis also depends on the expertise of the operator. Difficulty in analyzing some images, so it is necessary to combine with other techniques such as X-ray, magnetic resonance,... to come to a final conclusion.

2. When is an ultrasound of the pleural cavity indicated?

Pleural ultrasound may be indicated in cases of suspected pleural injury such as pleural effusion, especially in the case of hemothorax, pleural effusion due to pathology or after procedure. In addition, this method should also be performed in the following cases:
Determine if the chest wall and pleural lesions are tumors or fluid. Assess diaphragmatic movement, distinguishing between pleural effusions and localized diaphragmatic fluid. Helps detect as well as identify cases of pleural thickening or pleural tumor invading the chest wall. Methods such as puncture, drainage, pleural biopsy can be done with the help of pleural ultrasound. Detect pneumothorax

3. How is pleural ultrasound done?

The patient does not need to prepare anything before the pleural ultrasound. Ultrasound can be performed in a sitting or lying position depending on the position to be examined in order to best reveal the area to be ultrasound:
Sitting position: use the ultrasound probe on the intercostal spaces to examine the chest wall disease, pleura and effusion. Lying position: The ultrasound probe examines the lateral and posterior costal angle of the diaphragm, the bottom of the lung parenchyma, taking the liver as the window to evaluate the diaphragm and pleura. The ultrasound probe will be moved along the intercostal space from the top of the lung to below the diaphragm, if there is a suspicion of injury, it is necessary to take time to observe the abnormalities in the respiratory rhythms as well as compare with the opposite side. Pleural effusion is identified in the following cases:
On ultrasound, there is a uniform negative space between the parietal and visceral leaves Depending on the cause of the hemothorax, the ultrasound may show single images or the The combination of 4 levels of sound resistance including: drum sound, mixed sound without septa, mixed sound with septum and homogenous boost

To estimate the degree of pleural effusion on ultrasound when using a 3.5 MHz transducer:
Very small amount: negative space is only seen in the costodiaphragm Moderate amount: negative space between 1-2 scan ranges of transducer High amount: negative space exceeds 2 scanning ranges of ultrasound probe Pneumothorax is diagnosed in pleural ultrasound when:
No image is seen Sliding lung image No comet tail image is seen. Pleural line is enlarged. Pleural ultrasound plays a very important role in examination, diagnosis and treatment of pleural effusion. Pleural ultrasound does not cause harm to health, can be performed many times, gives high accuracy results, low cost, and quick implementation process. However, the results of pleural ultrasound depend greatly on the ultrasound device, as well as the person performing the technique. Modern equipment will give sharper, more detailed and specific images. From there, it is easy to detect abnormal signs even at the early stages with very small symptoms. Vinmec International General Hospital is the leading prestigious medical examination and treatment facility in the country. Vinmec owns the most modern and advanced medical equipment system in the world. Together with a team of highly qualified and experienced doctors, they bring optimal treatment results to patients.

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