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It is of vital importance to identify the pleural line when performing lung ultrasound, as the pleural line not only indicates the interface between the chest wall and lung, but offers additional diagnostic information. In the current clinical practice, the pleural line is visually detected and evaluated by clinicians, which requires experiences and skills with challenges for the novice. In this study, we developed a computer-aided technique for automated pleural line detection using ultrasound. The method first utilized the Radon transform to detect line objects in the ultrasound images. The relation of the body mass index and chest wall thickness was then applied to estimate the range of the pleural thickness, based on which the pleural line was detected together with the consideration of the ultrasonic properties of the pleural line. The proposed method was validated by testing 83 ultrasound data sets collected from 21 pneumothorax patients. The pleural lines were successfully identified in 76 data sets by the automated method (successful detection rate 91.6%). In those successful cases, the depths of the pleural lines measured by the automated method agreed with those manually measured as confirmed with the Bland-Altman test. The measurement errors were below 5% in terms of the pleural line depth. As a conclusion, the proposed method could detect the pleural line in an automated manner in the defined data set. In addition, the method may potentially act as an alternative to visual inspection after further tests on more diverse data sets are performed in future studies.

This paper proposes a quantitative analysis method for lung ultrasound (LUS) images to evaluate the severity of COVID-19 pneumonia. Specifically, biomarkers related to the pleural line, including the thickness of pleural line (TPL) and the roughness of pleural line (RPL), and biomarkers related to the B-lines, including the accumulated width of B-lines (AWBL) and the acoustic coefficient of B-lines (ACBL), are extracted from LUS images to characterize the image patterns associated with the disease severity. 27 patients of COVID-19 pneumonia are enrolled in this study, including 13 moderate cases, 7 severe cases, and 7 critical cases. Patients of moderate cases are regarded as non-severe patients, and patients of severe and critical cases are regarded as non-severe patients. Biomarkers among different cases are compared, and the performances in the binary diagnosis of severe and non-severe patients are assessed using a support vector machine (SVM) classifier with all the biomarkers as the input. The classification performance is optimal using the SVM classifier (area under the receiver operating characteristics curve = 0.93, sensitivity = 0.93, specificity = 0.85). The proposed method may be a promising tool for the automatic grading and follow-up of patients with COVID-19 pneumonia.

We used the lung ultrasound score (LUSS) to analyze the ultrasound images and assess the lesions and aeration loss in 12 lung regions of 11 COVID-19 neonates born to mother with COVID-19 and 11 age- and gender-matched controls. In the COVID-19 group, 132 regions were reviewed and 83 regions (62.8%) detected abnormalities. Compared with controls, COVID-19 neonates showed more increased B-lines (83 regions), abnormal A-lines (83 regions), abnormal pleural line (29 regions) and subpleural consolidation (5 regions). among which 49 regions (37%) were normal, 73 regions (55%) scored 1, and 10 regions (8%) scored 2. The LUSS was significantly higher in COVID-19 group. All the lesions were bilateral, multiple regions involved, and mainly located in bilateral lower lobes and right middle lobe. The intra-observer and inter-observer reproducibility of LUSS were excellent. Lung ultrasound is a noninvasive and convenient method for the assessment of neonatal COVID-19 pneumonia and presents typical signs. LUSS provides valuable semi-quantitative information about the lesion distribution and severity.

Background: The work wants to see if the Lung Sonography (LUS) can be helpful in the evaluation of a new device before and after a respiratory treatment. Aim: Simeox is a new device for airway clearway. The patient activates it using a button during the expiration phase that creates a negative vibratory suction of small volumes of air.The action is directed to the mucus rheology, improves the drainage from the periphery of the lung. Methods: 8 patients (4 female and 4 male), were examined by comparing LUS with traditional parameters such as SpO2 , FC, scales before and after a week’s use of the Simeox device and gym exercises. The ecography machine was set in B-mode with a convex probe oriented horizontally to have a greater view of the pleural line in the four Volpicelli’s zones. We took note on a map of number of the vertical artifacts B lines starting from the pleural line with a score from 0 to 4. Results: Lus and all parameters have improved but some patients, little compliant, were unable to tell if the amount of secretions had changed. The usual exams give the state of health but not the specific state of the lung such as LUS that represents a third eye, inner, in addition to the clinic exam. Conclusion: Our study suggests that LUS is a patient bedside exam modality, safe, reliable, fast to evaluate the alveolar drainage. Further studies are needed to understand the interaction of LUS with the respiratory treatments.

Introduction: Diagnosis and monitoring of interstitial lung disease (ILD) in children are mainly based on chest computed tomography (CT), resulting in significant exposure to x-rays. In adult patients, studies have shown a good sensitivity of the lung ultrasound (LUS) for detecting interstitial lesions, with a high correlation between LUS and CT images. The aim of this pilot study was to assess in children with ILD: (i) the feasibility of lung ultrasound and (ii) the comparability of LUS and CT images. Methods: LUS was performed in 5 children followed in the RespiRare® centre for an ILD of various aetiologies. Images visualized by LUS were described and compared to those seen at the latest chest CT. Results: The 5 children were 1.5, 2.5, 7, 11 and 16 years old respectively. Interstitial lesions were visualized by LUS in 4 of the 5 children, characterized by the presence of more than 3 confluent or spaced B lines per field, associated with an irregularity of the pleural line. Two children presented sub-pleural consolidations that were also seen on their CT. Bilateral pleural effusion was observed by LUS in one child. Only one child had a normal LUS while his CT showed some scattered micro-nodular lesions. Conclusion: This pilot study demonstrated a good correlation between LUS and CT images. As in adult patients, LUS could be an interesting tool for screening and monitoring children with ILD, reducing their exposure to x-rays in comparison to CT.

Objective To explore the reliability and accuracy of lung ultrasound for diagnosing neonatal pneumothorax. Methods This study was divided into two phases. (1) In the first phase, from January 2013 to June 2015, 40 patients with confirmed pneumothorax had lung ultrasound examinations performed to identify the sonographic characteristics of neonatal pneumothorax. (2) In the second phase, from July 2015 to August 2016, lung ultrasound was undertaken on 50 newborn infants with severe lung disease who were suspected of having pneumothorax, to evaluate the sonographic accuracy and reliability to diagnose pneumothorax. Results (1) The main ultrasonic manifestations of pneumothorax are as follows: ① lung sliding disappearance, which was observed in all patients (100%); ② the existence of the pleural line and the A-line, which was also observed in all patients (100%); ③ the lung point, which was found in 75% of the infants with mild-moderate pneumothorax but not found to exist in 25% of the severe pneumothorax patients; ④ the absence of B-lines in the area of the pneumothorax (100% of the pneumothorax patients); and ⑤ no lung consolidation existed in the area of the pneumothorax (100% of the pneumothorax patients). (2) The accuracy and reliability of the lung sonographic signs of lung sliding disappearance as well as the existence of the pleural line and the A-line in diagnosing pneumothorax were as follows: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. When the lung point exists, the diagnosis is mild-moderate pneumothorax, whereas if no lung point exists, the diagnosis is severe pneumothorax. Conclusion Lung ultrasound is accurate and reliable in diagnosing and ruling out neonatal pneumothorax and, in our study, was found to be as accurate as chest X-ray.

Objectives 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. Methods 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. Results 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%). Conclusions 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.

The aim of the study was to assess the significance and diagnostic concert of pleural line aberrations and B-lines detected by high-resolution transthoracic sonography (TS) in contradiction of the high resolution computed tomography (HRCT) findings. The pleural lines and accompanying B-line were assessed using a linear transducer. The TS findings were assessed against the corresponding HRCT findings in the same location, which were considered to be the gold standard. Among 320 patients, pleural line changes were detected in 240 patients (75%) on TS. The characteristic variations of the pleural line were categorized into four types: slightly rough pleural line with confluent B-lines on TS corresponded with HRCT 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 in 96 cases (30%). In conclusion, High-frequency TS may help in the early assessment of lung pathology by its ability to recognize pleural line anomalies and B-lines that are shown to be associated with CT changes, which could add diagnostic value in the emergency assessment of dyspneic patients.

Ultrasound examination of the chest has advanced in recent decades. This imaging modality is currently used to diagnose several pathological conditions and provides qualitative and quantitative information. Acoustic barriers represented by the aerated lungs and the bony framework of the chest generate well-described sonographic artifacts that can be used as diagnostic aids. The normal pleural line and A, B, C, E and Z lines (also known as false B lines) are artifacts with specific characteristics. Lung consolidation and pneumothorax sonographic patterns are also well established. Some scanning protocols have been used in patient management. The Blue, FALLS and C.A.U.S.E. protocols are examples of algorithms using artifact combinations to achieve accurate diagnoses. Combined chest ultrasonography and radiography are often sufficient to diagnose and manage lung and chest wall conditions. Chest ultrasonography is a highly valuable diagnostic tool for radiologists, emergency and intensive care physicians. RESUMO O exame ultrassonográfico do tórax avançou nas últimas décadas, sendo utilizado para o diagnóstico de inúmeras condições patológicas, e fornecendo informações qualitativas e quantitativas. Os pulmões aerados e o arcabouço ósseo do tórax representam barreira sonora para o estudo ultrassonográfico, gerando artefatos que, bem conhecidos, são utilizados como ferramentas diagnósticas. Eco pleural normal, linhas A, linhas B, linhas C, linhas E e Z (conhecidas como falsas linhas B) são artefatos com características peculiares. Os padrões de consolidação e de pneumotórax também são bem estabelecidos. Alguns protocolos têm sido utilizados no manuseio dos pacientes: Blue Protocol, Protocolo FALLS e Protocolo C.A.U.S.E são exemplos de três propostas que, por meio da associação entre os artefatos, permitem sugerir diagnósticos precisos. A ultrassonografia de tórax, aliada à radiografia de tórax, muitas vezes é suficiente para o diagnóstico e a conduta das afecções pulmonares e da parede torácica. Trata-se de ferramenta diagnóstica de grande valia para médicos radiologistas, emergencistas e intensivistas.

Transthoracic lung ultrasound (TLU) is a non-invasive and easily accessible method for diagnosing diseases of the pleura and lung. No ionizing radiation allows its use in people with diseases such as Nijmegen breakage syndrome (NBS) or pregnant women. Possibility of repeated studies allows to monitoring therapy. The method uses the artifacts caused by changes out to the periphery of the lungs. Visualization of specific artifacts in lung ultrasound in conjunction with the medial examination often allows the correct diagnosis. In addition, the sensitivity and specificity of TLU are often comparable to the radiological examination and computed tomography. Another advantage is the availability and the short duration of the study which is important in emergency cases. The article presents study techniques and basic artifacts evaluated in TLU. Proper pleural line is characterized by equal outlines, without irregularities. The movement of the pleura is called “lung sliping sign”. Acoustic shadows of two adjacent ribs and pleural line form the so-called “bat sign”. The main artifacts assessed in TLU include artifacts line A, line B and line Z.

Knowledge of lung ultrasound characteristics of coronavirus disease 2019 pneumonia might be useful for early diagnosis and clinical monitoring of patients, and lung ultrasound can help to control the spread of infection in healthcare settings. In this case report, a 36-year-old man with severe acute respiratory syndrome coronavirus 2 infection was diagnosed by reverse transcription-polymerase chain reaction testing of a nasopharyngeal swab. The lung ultrasound findings for this patient were the interstitial-alveolar damage showing bilateral, diffuse pleural line abnormalities, subpleural consolidations, white lung areas and thick, irregular vertical artifacts. When the patient recovered from the severe acute respiratory syndrome coronavirus 2 infection, lung ultrasound images showed a normal pleural line with A-lines regularly reverberating. Performing lung ultrasound at the bedside minimizes the need to move the patient, thus reducing the risk of spreading infection among healthcare staff. Lung ultrasound is useful for early diagnosis and evaluation of the severity of coronavirus disease 2019 pneumonia and for monitoring its progress over the course of the disease.

Lung ultrasound is a basic application of critical ultrasound, defined as a loop associating urgent diagnoses with immediate therapeutic decisions. It requires the mastery of ten signs: the bat sign (pleural line), lung sliding (yielding seashore sign), the A-line (horizontal artifact), the quad sign, and sinusoid sign indicating pleural effusion, the fractal, and tissue-like sign indicating lung consolidation, the B-line, and lung rockets indicating interstitial syndrome, abolished lung sliding with the stratosphere sign suggesting pneumothorax, and the lung point indicating pneumothorax. Two more signs, the lung pulse and the dynamic air bronchogram, are used to distinguish atelectasis from pneumonia. All of these disorders were assessed using CT as the “gold standard” with sensitivity and specificity ranging from 90% to 100%, allowing ultrasound to be considered as a reasonable bedside “gold standard” in the critically ill. The BLUE-protocol is a fast protocol (

For exploring the most voluminous organ, three points allow standardized protocols, expedite the investigation of critically ill patients, and warrant the accuracy published in the BLUE-protocol native article.

The monitoring of vital functions, based on technologically advanced instruments, is pivotal in intensive care unit.

A few seconds are sufficient to rule out pneumothorax, less than 1 min to rule it in, at the bedside. This justifies the length of the present chapter.

Notions of the physical properties of ultrasound are not indispensable for the user (as we wrote in our 1992, 2002, 2005, 2010, and 2011 editions). Interested readers will find them in any ultrasound textbook.

Lung ultrasound is a standardized domain. Each of its components is based upon pathophysiological realities. As for any novelty, a new terminology had to be considered. The one used in the BLUE-protocol favors fast communication, in the spirit of aviation language: maximal information in minimal time.

Supported by an increasing number of papers, chest ultrasound is rising as the first step diagnostic tool in emergency situations.

Lung ultrasound (LUS) has recently been proposed as a new sonographic application to image pulmonary interstitial syndrome through evaluation of B-lines, discrete laser-like vertical hyperechoic reverberation artifacts that arise from the pleural line, extend to the bottom of the screen, and move

To the editor:I read with interest the article from Caiulo and colleagues[2].Since Lichtenstein described new applications of chestsonography in adults [3],some authorshave published onitsapplication in children, and this topic has become verypopulargiven the absence of radiation. The article by Caiuloet al. focused on bronchiolitis, defined as infection of thesmall airways and whose radiologic clues are hyperinflationand peripheral atelectasis [1].It is therefore surprising that, in their study, hyperinfla-tion was evident in only 1/52 infants with bronchiolitis.Concerning the ultrasound (US) pattern, we are doubtfulabout the real meaning of small subpleural lung consolida-tions and pleural line abnormalities. US cannot reliablydifferentiate pneumonia from atelectasis, which is—on theother hand—often associated with severe pneumonia [5].Furthermore, according to the experience derived from chestCT in early childhood, these aspects can be related also toincomplete expansion of the alveoli [4], which are oftenincidentally observed in healthy lungs investigated for otherreasons.

Newborns, infants, and children do not show at lung ultrasound examination a different picture than adults. Also, the pathological changes described in adults diseases are similar.

Hydropneumothorax may be diagnosed on a supine radiograph by recognition of a pleural line with increased density lateral to it in the pleural space. Recognition of this condition may have implications for therapeutic chest tube placement.

Widening of the paraspinal pleural line on the supine anteroposterior overexposed grid roentgenogram of the chest is proposed as an early diagnostic indicator of free pleural effusions. This finding is more often observed on the left than on the right side.