Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water☆
Section snippets
Patients
From January to April 2002, 121 consecutive patients (aged 67 ± 12 years; 43 women and 78 men) admitted to our adult cardiology-pneumology department were included in the study. The inclusion criteria were: (1) in-hospital patients (admitted to our department), (2) chest x-ray on admission or repeated chest x-ray, and (3) echocardiogram for specific assessment of lung comets performed within a few minutes of chest x-ray. Exclusion criteria were: (1) time lag between chest x-ray and chest
Results
In all, 135 paired echos (chest x-ray evaluations) were obtained in 121 patients. Thirteen patients were studied twice (at admission and on discharge), and 1 patient was studied 3 times. Reasons for hospital admission were acute coronary syndrome in 10 patients, stable angina in 37, dyspnea in 33, exacerbation of chronic heart failure in 9, and miscellaneous causes (worsening of chronic pulmonary disease after coronary artery bypass surgery, atrial fibrillation, palpitation, pulmonary embolism,
Discussion
Previous studies have clarified the likely biophysical mechanism underlying the comet-tail artifact.1, 2 All diagnostic ultrasound methods are based on the principle that ultrasound is reflected by an interface between media of different acoustic impedance.6 In normal conditions, with the transducer positioned on the chest wall, the ultrasound beam finds the lung air (i.e., high impedance and no acoustic mismatch on its pathway through the chest) (Figure 7). In the presence of extravascular
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Dr. Jambrik is a visiting fellow from the University of Szeged, Szeged, Hungary, and is supported by the “Eötvös” Educational Grant from the Hungarian Government Budapest, Hungary, and by the “Research and Training Fellowship” of the European Society of Cardiology, Nice, France.