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array:18 [ "pii" => "13055457" "issn" => "15792129" "estado" => "S300" "fechaPublicacion" => "2003-12-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2003;39:535-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3558 "formatos" => array:3 [ "EPUB" => 132 "HTML" => 2642 "PDF" => 784 ] ] "itemSiguiente" => array:15 [ "pii" => "13055458" "issn" => "15792129" "estado" => "S300" "fechaPublicacion" => "2003-12-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2003;39:537-43" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3754 "formatos" => array:3 [ "EPUB" => 145 "HTML" => 2712 "PDF" => 897 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Validation Study of a Polygraphic Screening Device (BREAS SC20) in the Diagnosis of Sleep Apnea-Hypopnea Syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "537" "paginaFinal" => "543" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de la validez de un equipo de poligrafía respiratoria (BREAS SC-20) para el diagnóstico del síndrome de apneas-hipopneas durante el sueño" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R Núñez, J Rey de Castro, E Socarrás, JM Calleja, R Rubio, F Aizpuru, J Durán-Cantolla" "autores" => array:7 [ 0 => array:2 [ "Iniciales" => "R" "apellidos" => "Núñez" ] 1 => array:2 [ "Iniciales" => "J" "apellidos" => "Rey de Castro" ] 2 => array:2 [ "Iniciales" => "E" "apellidos" => "Socarrás" ] 3 => array:2 [ "Iniciales" => "JM" "apellidos" => "Calleja" ] 4 => array:2 [ "Iniciales" => "R" "apellidos" => "Rubio" ] 5 => array:2 [ "Iniciales" => "F" "apellidos" => "Aizpuru" ] 6 => array:2 [ "Iniciales" => "J" "apellidos" => "Durán-Cantolla" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13055458?idApp=UINPBA00003Z" "url" => "/15792129/0000003900000012/v0_201307090853/13055458/v0_201307090853/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Ultrasound in Pulmonology: the Current Situation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "535" "paginaFinal" => "536" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "MA de Gregorio, H D'Agostino" "autores" => array:2 [ 0 => array:3 [ "Iniciales" => "MA" "apellidos" => "de Gregorio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "H" "apellidos" => "D'Agostino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Full Professor of Radiology, School of Medicine, Health Sciences Center, Louisiana State University, Baton Rouge, LA, USA. Profesor titular de Radiología, Universidad de Zaragoza, Zaragoza, Spain." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Full Professor of Radiology, School of Medicine, Health Sciences Center, Louisiana State University, Baton Rouge, LA, USA." "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La ultrasonografía en neumología: situación actual" ] ] "textoCompleto" => "<p class="elsevierStylePara"> Ultrasound--or echography--has emerged as a powerful tool for those who study diseases of the chest as it has for other specialists. Once a rarely used technique, ultrasound is now indicated for most thoracic diseases. In the past, use was infrequent because of certain inherent limitations of the technique: the bones and the air space of the lung parenchyma create an acoustic barrier that impedes and reflects sound waves, thereby producing major artifacts. In short, given that these two thoracic structures (the bones and the lung parenchyma) represent more than 80% of the content of the chest, the value of ultrasound as a diagnostic tool for the thorax might understandably be questioned.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara"> Moreover, in challenging the place of conventional radiography--the undisputed first choice for diagnostic imaging of the thorax--ultrasound has tough competition from magnetic resonance imaging, and, especially, computed tomography in its many varieties (high-resolution, spiral, multidetector row). Both techniques have shown their value in diagnosing chest diseases: their high resolution and multiplanar viewing capability provide a better approximation of anatomical reality than surgery or even traditional anatomical dissection. Pathological alterations may be observed from any perspective: axial, sagittal coronal, or parasagittal. It is even possible to produce three-dimensional reconstructions from this data, leading to what is today known as virtual bronchoscopy (of the entire tracheobronchial tree) or virtual angioscopy (of the pulmonary and mediastinal blood vessels).<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara"> What advantages does ultrasound offer to support its use in diagnosing thoracic diseases? Ultrasound is innocuous, mobile, easy to use, inexpensive, accessible, and can be viewed in real time. These inherent virtues, despite the aforementioned technical drawbacks, provide significant incentives.</p><p class="elsevierStylePara">The widespread use of real time imaging and small, high frequency transducer probes permit the narrow windows of the intercostal spaces to be used effectively in thoracic evaluation. Moreover, adding ultrasound imaging capability to fiberoptic endoscopes used in the esophagus and bronchi extends and enhances their usefulness for examining peribronchial and mediastinal spaces.<span class="elsevierStyleSup">3,4</span></p><p class="elsevierStylePara"> Traditional indications for ultrasound, such as the diagnosis of chest wall diseases and pleural effusion, are widely known and used. Without having to move the patient, bedside ultrasound can detect even a few milliliters of fluid in the pleural space. The characteristic echographic pattern of the pleural fluid is anechoic (without echoes) with a posterior band of hyperechoic reflection, while solid lesions are echogenic to a greater or lesser extent.<span class="elsevierStyleSup">5</span> Pleural transudate is generally anechoic whereas pleural exudate, with its greater protein content (>3 g/100 mL), has echogenic septa and may even be homogeneously echogenic.<span class="elsevierStyleSup">6</span> However, certain solid tumors located in the pleura, especially lymphomas and some neurogenic tumors, appear as anechoic masses because they transmit ultrasonic waves, possibly leading to diagnostic error. On the other hand, some pleural exudates and empyema appear as echoic lesions and may even appear hyperechoic at times. This is why the specificity of ultrasound in differentiating solids from liquids is not 100%.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara"> Ultrasound has other indications in the thorax that are less widely known and applied; this does not, however, make them any less valid. Thoracic trauma affecting soft tissues and bony structures, as well as pneumothorax of any origin, can be diagnosed by ultrasound. Several studies have shown that ultrasound can even improve on the results of conventional radiography in fractures of the sternum and ribs.<span class="elsevierStyleSup">7,8</span> Rowan et al,<span class="elsevierStyleSup">9</span> in a recent study of 27 patients suspected of having traumatic pneumothorax, showed that ultrasound was more sensitive than supine chest radiography and as sensitive as computed tomography. Moreover, ultrasound, whether percutaneous or endoscopic, is effective for examining problems of the diaphragm, heart, pericardium, and the large arteries and veins of the thorax.<span class="elsevierStyleSup">10-12</span> Considering these indications, the benefits of ultrasound for emergency assessment of chest injury in the polytraumatized patient are evident, particularly when patient mobility is compromised or computed tomography is unavailable.<span class="elsevierStyleSup">13</span></p><p class="elsevierStylePara"> Doppler duplex ultrasound, with or without color, has been shown to have a sensitivity and specificity similar to phlebography in diagnosing venous thrombosis of the inferior vena cava and the extremities. Doppler ultrasound is also able to accurately diagnose the presence of a thrombus in cardiac cavities or in the trunk of the pulmonary artery. Currently, the usefulness of this technique in the treatment of venous thromboembolism and, more specifically, pulmonary embolism is unquestioned.<span class="elsevierStyleSup">14,15</span></p><p class="elsevierStylePara"> Ultrasound was originally presented as an imaging technique to assist in the diagnosis of interstitial lung diseases because it provided information on associated pleural pathology and subpleural lung infiltrates, especially in follow-up studies.<span class="elsevierStyleSup">15</span></p><p class="elsevierStylePara">The application of ultrasonic techniques to thoracic interventions has improved and advanced many invasive procedures that were once performed with the guidance of a fluoroscope. Biopsies of lung nodules (peripheral masses in contact with the pleural viscera) as well as drainage of pleural and pericardial effusions, mediastinal and lung abscesses, and pneumothorax can all be performed safely and effectively using ultrasound guidance, with no need for radiation.<span class="elsevierStyleSup">16-20</span> With ultrasound, follow up and monitoring of these interventions can be carried out easily and inexpensively at the patient´s bedside.<span class="elsevierStyleSup">21</span> Ultrasound facilitates correct access to the great central venous pathways, principally the jugular and subclavian veins.</p><p class="elsevierStylePara">In the future, diagnostic and research applications may move toward using ultrasound in conjunction with endoscopic devices, such as fiberoptic bronchoscopes, esophagogastroscopes, pleuroscopes, and laparoscopes. Encouraging results have already been reported.<span class="elsevierStyleSup">3,22</span> In this sense, technological improvements and new advances will soon permit the use of ultrasound to explore the segmental and subsegmental bronchi, the pleural space, the mediastinum, and any adjacent lesion.</p><p class="elsevierStylePara">The present relevance and future promise of ultrasound in respiratory medicine is manifest; however, the role of the pulmonologist in ultrasound remains to be determined. At present, thoracic ultrasound is provided by radiology services, where highly satisfactory diagnostic yields have been achieved; nonetheless, caseloads and the increasing range of indications will determine the direction to be taken. Either central imaging services will receive more technical and human resources to respond adequately to demand, or, as has already occurred in other specialties, pulmonologists will have to insist on access to technical resources and prepare themselves to meet this need.</p><hr></hr><p class="elsevierStylePara">Correspondence: Dr. M.A. Gregorio.<br></br> Facultad de Medicina. Universidad de Zaragoza. Zaragoza. España.</p><p class="elsevierStylePara">Manuscript received June 3, 2003. Accepted for publication June 17, 2003.</p>" "pdfFichero" => "260v39n12a13055457pdf001.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Thoracic sonography." 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Original language: English
Year/Month | Html | Total | |
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2024 November | 4 | 3 | 7 |
2024 October | 41 | 21 | 62 |
2024 September | 38 | 19 | 57 |
2024 August | 66 | 32 | 98 |
2024 July | 51 | 27 | 78 |
2024 June | 46 | 39 | 85 |
2024 May | 57 | 42 | 99 |
2024 April | 43 | 20 | 63 |
2024 March | 25 | 29 | 54 |
2024 February | 23 | 44 | 67 |
2023 March | 16 | 7 | 23 |
2023 February | 39 | 24 | 63 |
2023 January | 27 | 41 | 68 |
2022 December | 49 | 33 | 82 |
2022 November | 45 | 35 | 80 |
2022 October | 47 | 34 | 81 |
2022 September | 73 | 22 | 95 |
2022 August | 67 | 44 | 111 |
2022 July | 34 | 41 | 75 |
2022 June | 44 | 26 | 70 |
2022 May | 42 | 31 | 73 |
2022 April | 58 | 44 | 102 |
2022 March | 49 | 51 | 100 |
2022 February | 61 | 43 | 104 |
2022 January | 50 | 33 | 83 |
2021 December | 37 | 44 | 81 |
2021 November | 58 | 45 | 103 |
2021 October | 61 | 46 | 107 |
2021 September | 39 | 42 | 81 |
2021 August | 50 | 45 | 95 |
2021 July | 36 | 29 | 65 |
2021 June | 61 | 38 | 99 |
2021 May | 50 | 45 | 95 |
2021 April | 147 | 115 | 262 |
2021 March | 64 | 31 | 95 |
2021 February | 61 | 33 | 94 |
2021 January | 45 | 13 | 58 |
2020 December | 41 | 23 | 64 |
2020 November | 38 | 22 | 60 |
2020 October | 30 | 17 | 47 |
2020 September | 30 | 15 | 45 |
2020 August | 25 | 20 | 45 |
2020 July | 25 | 26 | 51 |
2020 June | 28 | 15 | 43 |
2020 May | 36 | 15 | 51 |
2020 April | 45 | 15 | 60 |
2020 March | 51 | 14 | 65 |
2020 February | 60 | 20 | 80 |
2020 January | 30 | 19 | 49 |
2019 December | 47 | 23 | 70 |
2019 November | 28 | 14 | 42 |
2019 October | 25 | 14 | 39 |
2019 September | 28 | 9 | 37 |
2019 August | 34 | 17 | 51 |
2019 July | 21 | 4 | 25 |
2019 June | 22 | 7 | 29 |
2019 May | 35 | 12 | 47 |
2019 April | 40 | 23 | 63 |
2019 March | 61 | 25 | 86 |
2019 February | 56 | 22 | 78 |
2019 January | 33 | 27 | 60 |
2018 December | 35 | 13 | 48 |
2018 November | 61 | 27 | 88 |
2018 October | 65 | 18 | 83 |
2018 September | 29 | 15 | 44 |
2018 May | 19 | 0 | 19 |
2018 April | 30 | 6 | 36 |
2018 March | 38 | 3 | 41 |
2018 February | 32 | 4 | 36 |
2018 January | 31 | 7 | 38 |
2017 December | 37 | 3 | 40 |
2017 November | 29 | 3 | 32 |
2017 October | 35 | 7 | 42 |
2017 September | 36 | 5 | 41 |
2017 August | 38 | 9 | 47 |
2017 July | 41 | 7 | 48 |
2017 June | 48 | 7 | 55 |
2017 May | 43 | 3 | 46 |
2017 April | 36 | 5 | 41 |
2017 March | 48 | 11 | 59 |
2017 February | 40 | 4 | 44 |
2017 January | 16 | 2 | 18 |
2016 December | 37 | 7 | 44 |
2016 November | 41 | 9 | 50 |
2016 October | 56 | 15 | 71 |
2016 September | 69 | 17 | 86 |
2016 August | 48 | 7 | 55 |
2016 July | 33 | 8 | 41 |
2016 May | 1 | 7 | 8 |
2016 April | 0 | 3 | 3 |
2016 March | 3 | 0 | 3 |
2016 February | 2 | 3 | 5 |
2016 January | 0 | 17 | 17 |
2015 December | 4 | 19 | 23 |
2015 November | 3 | 10 | 13 |
2015 October | 33 | 3 | 36 |
2015 September | 39 | 10 | 49 |
2015 August | 31 | 14 | 45 |
2015 July | 30 | 8 | 38 |
2015 June | 29 | 11 | 40 |
2015 May | 50 | 9 | 59 |
2015 April | 29 | 5 | 34 |
2015 March | 34 | 8 | 42 |
2015 February | 27 | 3 | 30 |
2015 January | 28 | 5 | 33 |
2014 December | 37 | 5 | 42 |
2014 November | 35 | 6 | 41 |
2014 October | 43 | 12 | 55 |
2014 September | 34 | 5 | 39 |
2014 August | 35 | 10 | 45 |
2014 July | 23 | 8 | 31 |
2014 June | 33 | 21 | 54 |
2014 May | 38 | 9 | 47 |
2014 April | 45 | 3 | 48 |
2014 March | 46 | 10 | 56 |
2014 February | 35 | 10 | 45 |
2014 January | 35 | 7 | 42 |
2013 December | 34 | 8 | 42 |
2013 November | 21 | 6 | 27 |
2013 October | 27 | 8 | 35 |
2013 September | 32 | 9 | 41 |
2013 August | 42 | 24 | 66 |
2013 July | 35 | 11 | 46 |
2013 June | 37 | 10 | 47 |
2013 May | 32 | 6 | 38 |
2013 April | 17 | 7 | 24 |
2013 March | 9 | 2 | 11 |