CHEST ULTRASOUND

DR. UKACHUKWU I. H.
MBBS (IBADAN), FWACS (RADIOLOGY),
CERT. INTERV. RADIOLOGY (GERMANY)
OUTLINES

 INDICATONS
 TECHNIQUES
 COMMON CHEST CONDITIONS
- PLEURAL EFFUSION, EMPYEMA,
MALIGNANT ASCITIS, PLEURAL
METASTASIS
 CONGENITAL ABNORMALITIES
 CONCLUSIONS
 INDICATIONS FOR CHEST USS
• Confirming normal or ectopic thymus.
• Characterising peripheral opacity (i.e.
parenchymal versus pleural disease)
• Characterising a mediastinal lesion.
• Assessing diaphragmatic motion & anatomical
abnormalities.
• Diagnosing palpable chest wall lesion.
• Localising pleural fluid for thoracentesis or a mass
for biopsy.
 ACOUSTIC WINDOWS FOR CHEST USS

 (1) supraclavicular;
 (2) suprasternal;
 (3) parasternal;
 (4) trans-sternal;
 (5) intercostal;
 (6) subxiphoid;
 (7) subdiaphragmatic;
 (8) posterior paraspinal
approaches.
 Normal pleura and lung.
 TV of the normal pleural surface (arrows) and the
aerated lung imaged with a high-frequency ultrasound
 Echogenic reverberations (arrowheads) are seen within
the aerated lung. CC, costochondral cartilages of the
ribs.
 A longitudinal view of
the right hemithorax
shows a large pleural
effusion (E)
containing multiple
internal echoes. L,
Lung; LIV, liver.
 A longitudinal view of
the right hemithorax
in a 12-year-old girl
with CHF
demonstrates a large
anechoic pleural
effusion (E). Also
noted is adjacent
atelectatic lung (AL).
LIV, liver.
 PLEURAL EFFUSION
Intercostal scan
 Anechoic to homogeneously hypoechoic space between
visceral and parietal pleura
 Floating echodensities
 Moving septations
 Shape corresponding to pleural space
 Lung movement within fluid
Abdominal scan
 Anechoic or hypoechoic fluid above the diaphragm
 Absence of mirror-image reflection of liver or spleen above the
diaphragm
 Visualization of the posterior wall of the thorax through the
fluid collection
Quantification of Pleural
Effusion Volume
SONOGRAPHIC SIGNS OF
TRANSUDATE / EXUDATE EFFUSION

TRANSUDATE EXUDATE

ANECHOIC FLUID ANECHOIC FLUID

ECHOGENIC FLUID +
FLOATING DENSITIES
SEPTATIONS OR FIBRIN
STRANDS
THICKENEND PLEURA
PLEURAL NODULES
CAUSES OF PLEURAL EFFUSION
CONGESTIVE HEART FAILURE EXUDATE
CIRRHOSIS PARA PNEUMONIC EFFUSION
NEPHROTIC SYNDROME TUBERCULOSIS PLEURISY
HYPOALBUMINEMIA EMPYEMA
CONSTRICTIVEN PERICARDITIS HEMOTHORAX
SUPERIOR VENA CAVA COLLAGEN VASCULAR DISEASE
OBSTRUCTION
INTRAABDOMINAL ABSCESSES
HEPATIC, SUBPHRENIC,
PANCREATITIS
NEOPLASMS
- METASTASIS
- BRONCHOGENIC CA
- MESETHELIOMA
 COMPLEX EFFUSION
 Complex effusion. A
longitudinal view of the right
hemithorax in a 10-year-old girl
with pneumonia demonstrates a
large complex pleural effusion
with multiple internal septations
(arrows). LIV, liver

 Empyema. A transverse view of

the left lower hemithorax shows
a large pleural effusion (E)
containing echogenic particles,
septations and heterogeneous
adjacent lung parenchyma
(arrows).
CAUSES OF EMPYEMA
BACTERIAL PNEUMONIA
LUNG ABSCESS
THORACIC SURGERY
TRAUMA
SUBPHRENIC ABSCESS
SPINAL OSTEOMYELITIS
 PARENCHYMAL CONSOLIDATION
Transverse view of a consolidated
right lower lobe demonstrates
multiple bright punctuate and
branching linear structures
(arrows)’sonographic air
bronchogram’ sign. A small
amount of pleural effusion (E)

 Longitudinal colour Doppler

scan of the right lower
hemithorax branching
pulmonary vessels (arrows)
within the consolidated lung (L).
LIV, liver.
 Sonographic Signs of
Pulmonary Consolidation
 Homogeneous hypoechoic lung
 Wedge shape
 Well defined peripherally by
visceral pleura
 Ill defined centrally
 Sonographic air bronchograms
 Sonographic fluid
bronchograms
 Sonographic air alveolograms
 Appropriate motion with
respiration
 Sonographic Signs of
Pulmonary Atelectasis
 Wedge-shaped echogenic
lung tissue
 Volume loss
 Crowding of fluid filled
bronchi/vessels
 Sonographic fluid
bronchograms
 No sonographic air
bronchograms
 Appropriate motion with
respiration
 Lung abscess. Transverse
view of the left lower lobe
ishows an oval-shaped
hypoechoic mass with
surrounding thick and
irregular walls (arrows).

 Lung abscess. Transverse

view of the right lower shows
a hypoechoic mass containing
a hyperechoic focus,
representing gas (arrowhead).
The abscess is surrounded by
thick and irregular walls
(arrows)
 PNEUMOTHORAX

 ECHOGENIC LINE -
bright interface (arrow )
No respiratory
movement.
Reverberation (Rev)
artifact. This is indicative
of development of a
pneumothorax.
 PLEURAL METASTASIS
 Pleural metastases. A: A
transverse view of the left lower
hemithorax immature teratoma
demonstrates an echogenic mass (M)
surrounded by a complex pleural
effusion (E).

 Pleural metastases. A longitudinal

view of the right lower hemithorax in a
16-year-old girl with a known
metastatic papillary thyroid
carcinoma shows multiple echogenic
pleural based metastatic nodules
(arrows). L, lung. LIV, liver
 Congenital abnormality
 Cystic adenomatoid
malformation.
demonstrates a large cystic
lesion (C) with thin walls,
consistent with a type 1
CCAM

 Cystic adenomatoid
malformation. mass shows
multiple cystic lesions (C)
with thin walls, consistent
with a type 2 CCAM. LIV,
liver.
CONCLUSION

 CHEST USS IS A USEFUL TOOL IN RAPID

DIAGNOSIS OF PLEURAL EFFUSION AND
SOM CHEST ABNORMALITIES, ALSO CAN
ASSISIT IN IMAGE GUIDED BIOPSIES AND
THORACOCENTESIS

 THANK YOU
REFERENCES

 Diagnostic Ultrasound J. MacGhanan

 Clinical ultrasound p. Allan