Clinical Image
Diagnosis of Pulmonary Infarction by Thoracic Ultrasonography
Diagnóstico de infarto pulmonar mediante ecografía torácica
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(B) Chest computed tomography showing extensive lung consolidation containing air bronchogram. 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Chest X-ray revealed consolidation in the right lower lobe (RLL) with effacement of the diaphragmatic silhouette. A diagnosis of complicated pneumonia was given, and a chest ultrasound was requested, which showed a small amount of pleural effusion and pleural-based, triangular subpleural consolidation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), with no Doppler signal (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), possibly indicating pulmonary infarction. Chest CT-angiogram was performed, confirming filling defects in the posterobasal and laterobasal segmental arteries of the RLL (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) with subpleural peripheral opacity in the posterobasal segment of the RLL (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D), with enhanced uptake corresponding to pulmonary infarction. The presence of “A-lines” in the ultrasound pattern has been described as indicative of pulmonary thromboembolism, with 81% sensitivity and 99% specificity if associated with deep vein thrombosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Pulmonary infarction can be identified as a pleural-based wedge-shaped hypoechoic lesion with well-defined borders.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> In our patient, chest ultrasonography performed after an initial suspicion of complicated pneumonia was crucial for reaching the correct diagnosis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pascual-Guardia S, Ausin-Herrero MP, Ripoll-Fuster E. Diagnóstico de infarto pulmonar mediante ecografía torácica. Arch Bronconeumol. 2018;54:158.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1834 "Ancho" => 1613 "Tamanyo" => 299284 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest ultrasound and computed tomography showing a filling defect in the segmental arteries of the RLL, and pleural-based, triangular subpleural consolidation, diagnosed as pulmonary thromboembolism with pulmonary infarction.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel approaches to ultrasonography of the lung and pleural space: where are we now?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Lichtenstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Breathe (Sheff)" "fecha" => "2017" "volumen" => "13" "paginaInicial" => "100" "paginaFinal" => "111" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Chest ultrasonography in pleurapulmonary disease]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.P. Gallego Gómez" 1 => "P. García Benedito" 2 => "D. Pereira Boo" 3 => "M. Sánchez Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rx.2012.03.008" "Revista" => array:6 [ "tituloSerie" => "Radiologia" "fecha" => "2014" "volumen" => "56" "paginaInicial" => "52" "paginaFinal" => "60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22819690" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005400000003/v3_201803080856/S1579212918300065/v3_201803080856/en/main.assets" "Apartado" => array:4 [ "identificador" => "21342" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical Image" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005400000003/v3_201803080856/S1579212918300065/v3_201803080856/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918300065?idApp=UINPBA00003Z" ]
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