Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China.
Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
Arthritis Res Ther. 2024 Sep 18;26(1):164. doi: 10.1186/s13075-024-03399-2.
Systemic autoimmune rheumatic diseases (SARDs) related pulmonary disease is highly prevalent, with variable clinical presentation and behavior, and thus is associated with poor outcomes and negatively impacts quality of life. Chest high resolution computed tomography (HRCT) is still considered a fundamental imaging tool in the screening, diagnosis, and follow-up of pulmonary disease in patients with SARDs. However, radiation exposure, economic burden, as well as lack of point-of-care CT equipment limits its application in some clinical situation. Ultrasound has found a place in numerous aspects of the rheumatic diseases, including the vasculature, skin, muscle, joints, kidneys and in screening for malignancies. Likewise it has found increasing use in the lungs. In the past two decades, lung ultrasound has started to be used for pulmonary parenchymal diseases such as pneumonia, pulmonary edema, lung fibrosis, pneumothorax, and pleural lesions, although the lung parenchymal was once considered off-limits to ultrasound. Lung ultrasound B-lines and irregularities of the pleural line are now regarded two important sonographic artefacts related to diffuse parenchymal lung disease and they could reflect the lesion extent and severity. However, its role in the management of SARDs related pulmonary involvement has not been fully investigated. This review article will focus on the potential applications of lung ultrasound in different pulmonary scenarios related with SARDs, such as interstitial lung disease, diffuse alveolar hemorrhage, diaphragmatic involvement, and pulmonary infection, in order to explore its value in clinical daily practice.
系统性自身免疫性风湿病(SARDs)相关的肺部疾病发病率很高,临床表现和行为多变,因此与不良预后相关,并对生活质量产生负面影响。胸部高分辨率计算机断层扫描(HRCT)仍然被认为是筛查、诊断和随访 SARD 患者肺部疾病的基本影像学工具。然而,辐射暴露、经济负担以及缺乏即时 CT 设备限制了其在某些临床情况下的应用。超声在许多风湿病领域都有应用,包括血管、皮肤、肌肉、关节、肾脏和恶性肿瘤的筛查。同样,它在肺部的应用也越来越广泛。在过去的二十年中,肺超声已经开始用于肺部实质疾病,如肺炎、肺水肿、肺纤维化、气胸和胸膜病变,尽管肺部实质曾经被认为是超声的禁区。肺超声 B 线和胸膜线不规则现在被认为是两种与弥漫性肺部疾病相关的重要超声伪像,它们可以反映病变的范围和严重程度。然而,其在 SARD 相关肺部受累管理中的作用尚未得到充分研究。本文综述了肺超声在与 SARD 相关的不同肺部情况下的潜在应用,如间质性肺疾病、弥漫性肺泡出血、膈肌受累和肺部感染,以探讨其在临床日常实践中的价值。