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Erschienen in:
20.07.2018 | Imaging in Intensive Care Medicine
Lung ultrasound in a dyspneic patient with giant bullae
Erschienen in: Intensive Care Medicine | Ausgabe 5/2019
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A 60-year-old man with exacerbated COPD and severe dyspnea was admitted to the intensive care unit (ICU). Lung auscultation revealed prolonged expiration and decreased vesicular breath sounds. Chest X-ray showed prominent hilar vascular shadows with no parenchymal consolidation and lung ultrasound was performed at ICU admission (Fig. 1a, b). A thoracic high resolution CT scan was performed in order to complete the COPD phenotype classification and this revealed a giant subpleural bullae (Fig. 1c).
Fig. 1
a Lung ultrasound at the anterior left upper BLUE-point with a 5-MHz microconvex probe, semirecumbent patient, sublongitudinal (short rib-axis view) scan, real time. Arrows 1, a few millimeters above the ribs. Arrow 2, pleural line. Arrow 3, one A-line, at roughly the expected location, here in a minimal variant. b Same ultrasound, M-mode. On this smart machine, both images are at exactly the same level, a critical detail in critical settings. Arrow 2, pleural line, exactly facing the left image. Three fine circles are displayed (to minimize spoiling the image). Their middles indicate subtle artifacts arising exactly at and just below the pleural line. On video, they appear repeatedly, in the manner of a Morse code, hence the Morse code sign. In this patient, this subtle semiology confidently allowed us to rule out a pneumothorax. c Thoracic CT scan. Panlobular emphysema with huge parenchymal destruction and giant subpleural bullae. Note where the (microconvex) probe was located
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