Mongodi Silvia, Colombo Andrea, Orlando Anita, Cavagna Lorenzo, Bouhemad Bélaid, Iotti Giorgio Antonio, Mojoli Francesco
Anaesthesia and Intensive Care, San Matteo Hospital, Viale Golgi 19, Pavia, Italy.
Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy.
Ultrasound J. 2020 May 15;12(1):27. doi: 10.1186/s13089-020-00174-7.
Lung ultrasound is a bedside non-irradiating tool for assessment and monitoring of lung diseases. A lung ultrasound score based on visualized artefacts allows reliable quantification of lung aeration, and is useful to monitor mechanical ventilation setting, fluid resuscitation and antibiotic response in critical care. In the context of interstitial lung diseases associated to connective tissue disorders, lung ultrasound has been integrated to computed tomography for diagnosis and follow-up monitoring of chronic lung disease progression.
This case describes a severe acute exacerbation of interstitial lung disease associated to dermatomyositis-polymyositis requiring prolonged extra-corporeal life support. Lung ultrasound score was performed daily and allowed monitoring and guiding both the need of advanced imaging as computed tomography and immunosuppressive therapy.
This case suggests lung ultrasound may be a useful monitoring tool for the response to immunosuppressive therapy in acute severe rheumatic interstitial lung disease, where chest X-ray is poorly informative, and transportation is at high risk.
肺部超声是一种用于评估和监测肺部疾病的床旁非辐射工具。基于可视化伪像的肺部超声评分可实现对肺通气的可靠量化，有助于在重症监护中监测机械通气设置、液体复苏和抗生素反应。在与结缔组织疾病相关的间质性肺疾病背景下，肺部超声已与计算机断层扫描相结合，用于慢性肺部疾病进展的诊断和随访监测。
本病例描述了与皮肌炎-多肌炎相关的间质性肺疾病严重急性加重，需要长时间的体外生命支持。每天进行肺部超声评分，可监测并指导对计算机断层扫描等高级成像的需求以及免疫抑制治疗。
本病例提示，在胸部X光片信息不足且转运风险高的急性严重风湿性间质性肺疾病中，肺部超声可能是监测免疫抑制治疗反应的有用工具。
