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01.12.2014 | Original article | Ausgabe 1/2014 Open Access

The Ultrasound Journal 1/2014

Lung ultrasound imaging in avian influenza A (H7N9) respiratory failure

The Ultrasound Journal > Ausgabe 1/2014
Nga Wing Tsai, Chun Wai Ngai, Ka Leung Mok, James W Tsung
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​2036-7902-6-6) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no conflicting or competing interests.

Authors’ contributions

NWT, CWN, KLM, and JWT participated in the conception and design of the study. NWT and CWN did the acquisition of data. NWT, CWN, KLM, and JWT participated in the analysis and interpretation of data. NWT, CWN, KLM, and JWT drafted the manuscript. NWT, KLM, and JWT participated in revising for critically important intellectual content. JWT supervised in the overall process. All authors read and approved the final manuscript.



Lung ultrasound has been shown to identify in real-time, various pathologies of the lung such as pneumonia, viral pneumonia, and acute respiratory distress syndrome (ARDS). Lung ultrasound maybe a first-line alternative to chest X-ray and CT scan in critically ill patients with respiratory failure. We describe the use of lung ultrasound imaging and findings in two cases of severe respiratory failure from avian influenza A (H7N9) infection.


Serial lung ultrasound images and video from two cases of H7N9 respiratory failure requiring mechanical ventilation and extracorporeal membrane oxygenation in a tertiary care intensive care unit were analyzed for characteristic lung ultrasound findings described previously for respiratory failure and infection. These findings were followed serially, correlated with clinical course and chest X-ray.


In both patients, characteristic lung ultrasound findings have been observed as previously described in viral pulmonary infections: subpleural consolidations associated or not with local pleural effusion. In addition, numerous, confluent, or coalescing B-lines leading to ‘white lung’ with corresponding pleural line thickening are associated with ARDS. Extension or reduction of lesions observed with ultrasound was also correlated respectively with clinical worsening or improvement. Coexisting consolidated pneumonia with sonographic air bronchograms was noted in one patient who did not survive.


Clinicians with access to point-of-care ultrasonography may use these findings as an alternative to chest X-ray or CT scan. Lung ultrasound imaging may assist in the efficient allocation of intensive care for patients with respiratory failure from viral pulmonary infections, especially in resource scarce settings or situations such as future respiratory virus outbreaks or pandemics.
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