Absence of lung sliding, presence of lung point(s), absence of B-lines, and absence Ruxolitinib structure of lung pulse. Lung ultrasound rules out the diagnosis of pneumothorax more accurately than a supine anterior chest X-ray (evidence level A). (ii) Interstitial Syndrome (Figures 3(e) and 3(f)). Presence of a B-profile consisting of more than 3 B-lines on a longitudinal scanning plane. Interstitial syndrome includes pulmonary edema, interstitial lung disorders and ARDS (evidence level B). [59, 61]. (iii) Lung Consolidation. Sonographic signs are a subpleural echo-poor region or one with tissue-like echotexture. Lung ultrasound can differentiate between consolidation of pulmonary embolism, pneumonia, and atelectasis (evidence level A). (iv) Pleural Effusion. A hypoechoic or anechoic space between sonoanatomical boundaries (i.

e., chest wall, the diaphragm and subdiaphragmatic organs). Lung ultrasound is more accurate than chest X-ray (evidence level A). (v) Monitoring Interstitial Syndrome. The number of B-lines is directly proportional to the severity of pulmonary congestion. This could be used as a monitoring parameter of severity and response to therapy (evidence level A). Pulmonary edema can be diagnosed, quantified, and monitored by detection of B-lines [62]. Pulmonary embolism (PE) (Figure 4), ��mainly peripheral�� can be diagnosed sonographically by the recognition of a peripheral, triangular, and pleural based hypoechoic lesion [5]. Mathis et al.

[63], in a multicenter study that involves 352 patients, defined diagnostic criteria as (1) PE confirmed: two or more typical triangular or rounded pleural-based lesions; (2) PE probable: one typical lesion with pleural effusion; (3) PE possible: small (<5mm) subpleural lesions or a single pleural effusion only. The sensitivity was 74%, specificity 95%, positive predictive value 95%, negative predictive value 75%, and accuracy 84%. Figure 4Pulmonary embolism: ((a) lung ultrasound) peripheral, triangular, and pleural based hypoechoic lesions (yellow arrows); ((b) transthoracic echo, apical view) it shows right ventricular (RV) dilation, RV hypokinesia, septal flattening, and tricuspid regurgitation. ...Laursen et al. [64] have studied the utility of lung ultrasound in near-drowning victims. Lung ultrasound showed multiple B-lines on the anterior and lateral surfaces of both lungs, consistent with pulmonary edema.

These findings may encourage anesthesiologists to consider lung ultrasound for diagnosing aspiration pneumonia during anesthesia. During positive pressure ventilation (PPV) a quantitative assessment of B-lines may aid in guiding diuretic or optimizing ventilator settings, particularly in conditions such as pulmonary edema or increased lung water content AV-951 [65]. In general, PPV supports the function of an impaired left ventricular (LV) by reducing the transmural pressure across the LV free wall (LV afterload is reduced).