Reissig Angelika, Kroegel Claus
Pneumology and Allergology/Immunology, Department I, Medical University Clinics, Friedrich Schiller University, Jena, Germany.
Respiration. 2007;74(5):537-47. doi: 10.1159/000100427. Epub 2007 Feb 27.
Although transthoracic ultrasound offers several important advantages as diagnostic imaging technique in pleural and pulmonary conditions, its significance for the diagnosis and monitoring of pneumonia has yet to be established.
To identify sonographic features associated with pneumonia at admission and during the course of the disease under treatment.
Thirty patients (12 females, 18 males; median age 65.5 years) with X-ray-proven pneumonia underwent transthoracic sonography (TS) on day 0, between days 1 and 3, 4 and 7, 8 and 14, 15 and 21, and after day 21. TS was assessed according to: number, location, shape, echogenicity, echotexture, echostructure, breath-depending movement, size of pneumonic lesions, bronchoaerogram, fluid bronchogram, superficial fluid alveologram, necrotic areas, vascularity and incidence of local and/or basal pleural effusion.
Thirty-three pneumonic infiltrates were eligible for analysis in 30 patients. In 57% (17/30), the likely pathogenic microorganism was identified. Pneumonia was recognized as a hypoechoic area of varying size (mean size between 33.7 x 9.38 and 91.2 x 45.3 mm) and shape, with irregular and blurred margins along with a nonhomogeneous echotexture. The most characteristic feature was a positive bronchoaerogram (32/33). Sixty-one percent (20/33) revealed basal and 9% (3/33) local effusion. During follow-up, lesions decreased in size or disappeared (30/33) or decreased in number (4/9). The bronchoaerogram became less pronounced (13/32), basal pleural effusion either diminished (7/20) or dissipated (7/20), as did localized effusion (3/3). In 30 cases, the course of pneumonia was comparable using X-ray and TS.
TS is a noninvasive technique for the diagnosis and follow-up of patients with pneumonia.
尽管经胸超声作为胸膜和肺部疾病的诊断成像技术具有若干重要优势，但其在肺炎诊断和监测中的意义尚未确立。
确定入院时及疾病治疗过程中与肺炎相关的超声特征。
30例经X线证实为肺炎的患者（12例女性，18例男性；中位年龄65.5岁）在第0天、第1至3天、第4至7天、第8至14天、第15至21天以及第21天之后接受经胸超声检查（TS）。根据以下方面对TS进行评估：肺炎性病变的数量、位置、形状、回声性、回声纹理、回声结构、呼吸依赖性运动、大小、支气管气像、液体支气管像、浅表液体肺泡像、坏死区域、血管分布以及局部和/或基底胸膜腔积液的发生率。
30例患者中有33个肺炎性浸润灶符合分析条件。57%（17/30）的患者确定了可能的致病微生物。肺炎表现为大小不等（平均大小在33.7×9.38至91.2×45.3毫米之间）、形状各异的低回声区，边缘不规则且模糊，回声纹理不均匀。最具特征性的表现是阳性支气管气像（32/33）。61%（20/33）出现基底积液，9%（3/33）出现局部积液。在随访过程中，病变大小减小或消失（30/33）或数量减少（4/9）。支气管气像变得不那么明显（13/32），基底胸膜腔积液减少（7/20）或消散（7/20），局部积液也是如此（3/3）。在30例患者中，使用X线和TS对肺炎病程的观察结果具有可比性。
TS是一种用于肺炎患者诊断和随访的非侵入性技术。
