ReviewTranscutaneous contrast-enhanced sonography of pleural-based pulmonary lesions
Introduction
In the chest, the value of ultrasound has traditionally been limited to the evaluation of pleural effusion and pleural-based lesions. Based on the dual arterial supply of the lung, this organ is, similar to the liver, suited for evaluation of arterial vascularity by contrast-enhanced sonography (CES) [1], [2], [3]. CES enables to differentiate and classify pulmonary from systemic bronchial arterial supply of lung lesions regarding time to enhancement and extend of enhancement after contrast agent infusion [4], [5]. The aim of this review is to describe CES patterns with a transcapillary second-generation contrast agent (SonoVue®, Braco) in patients with pleural-based lung lesions and to discuss possible indications for CES in patients with suspected chest diseases.
Section snippets
General considerations of CES
CES studies were performed immediately after baseline sonography with a contrast-devoted unit (Acuson-Sequoia GI, Siemens medical solution) that had contrast-specific, continuous-mode software. A low mechanical index was used. A sulfur hexafluoride-based microbubble contrast medium (SonoVue®) was injected intravenously within 2 s via a 20-gauge cannula. A volume of 2, 4 ml was administered, followed by a 5 ml saline flush. This contrast medium contains a low-solubility gas and is therefore
Pleurisy
Clinical sign of pleurisy is characterized by a breath dependent localized pleural pain, but the final diagnosis presents a considerable challenge and requires a high index of clinical suspicion from the attending physician. B-mode sonographic patterns as well as color Doppler sonographic (CDS) patterns of pleurisy/pleuropneumonia has been described [1], [2]. In a recent study [9], all patients with breath dependent pain due to pleurisy/pleuropneumonia do have a high specific CES pattern
Conclusion
CES of the chest is limited to pleural-based lesions. CES in peripheral lung lesions is feasible and depending on underlying diseases lesions may show a variable TE and EE. CES enables to distinguish pulmonary arterial supply from bronchial arterial supply by TE. First experiences with CES have shown that various peripheral lung lesions do have a characteristic CES pattern regarding TE and EE. First clinical data show that there are clinical conditions which may show a diagnostic advantage of
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