Li Hong, Li Yi-Dan, Zhu Wei-Wei, Sun Lan-Lan, Ye Xiao-Guang, Kong Ling-Yun, Cai Qi-Zhe, Jiang Wei, Wang Li, Lu Xiu-Zhang
Department of Echocardiography, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
J Ultrasound Med. 2017 Apr;36(4):707-716. doi: 10.7863/ultra.16.04030. Epub 2017 Jan 27.
Detection of B-line in dyspneic patients is often accompanied by abnormal changes of pleural line on transthoracic ultrasonography (TUS). The aim of the study was to evaluate the relevance and diagnostic performance of pleural line abnormalities and B-lines detected on high-resolution TUS against the computed tomography (CT) findings.
Transthoracic ultrasonography was performed in patients admitted to the emergency department with dyspnea. The pleural line and accompanying B-line were assessed using a linear transducer. The TUS findings were assessed against the corresponding high-resolution CT findings in the same location, which were considered to be the gold standard.
Out of a total of 116 patients, 68.1% had changes of the pleural line on TUS. The characteristic changes of the pleural line were classified into four types: slightly rough pleural line with confluent B-lines on TUS corresponded with CT findings of ground-glass opacity; irregular and interrupted pleural line with confluent B-lines corresponded with parenchymal infiltration; fringed pleural line with confluent B-lines corresponded with superimposed ground-glass and irregular reticular opacities; and fringed pleural line with scattered B-lines corresponded with irregularly thickened interlobular septa. Wavy pleural line indicated subpleural emphysema. The coexistence of more than one abnormal pleural line was also found in 31 cases (26.7%).
High-resolution TUS may help in the initial assessment of lung pathology by its ability to identify pleural line abnormalities and B-lines that are shown to be associated with CT, which could add diagnostic value in the emergency evaluation of dyspneic patients.
在呼吸困难患者中检测B线时，经胸超声检查（TUS）常伴有胸膜线异常改变。本研究旨在评估高分辨率TUS检测到的胸膜线异常和B线与计算机断层扫描（CT）结果的相关性及诊断性能。
对因呼吸困难入住急诊科的患者进行经胸超声检查。使用线性探头评估胸膜线及伴随的B线。将TUS检查结果与同一部位相应的高分辨率CT结果进行对照评估，后者被视为金标准。
在总共116例患者中，68.1%的患者TUS显示胸膜线有改变。胸膜线的特征性改变分为四种类型：TUS上胸膜线略粗糙且B线融合对应于磨玻璃影的CT表现；胸膜线不规则且中断伴有B线融合对应于实质浸润；胸膜线呈边缘状伴有B线融合对应于磨玻璃影和不规则网状影叠加；胸膜线呈边缘状伴有散在B线对应于小叶间隔不规则增厚。波浪状胸膜线提示胸膜下肺气肿。31例（26.7%）患者还存在不止一种胸膜线异常并存的情况。
高分辨率TUS能够识别与CT相关的胸膜线异常和B线，有助于对肺部病变进行初步评估，可为呼吸困难患者的急诊评估增加诊断价值。
