Abstract
Purpose of Review
Ultrasound is an invaluable tool and its use for thoracic procedures continues to expand. This review evaluates current use and evidence of ultrasound with thoracic procedures.
Recent Findings
• Ultrasound guidance assists with proper device placement and reduces the risk of complications.
• A low risk of pneumothorax can be achieved, even in high-risk populations, such as those receiving positive pressure ventilation.
• Contraindications for high-risk bleeding conditions, including coagulopathy and/or clopidogrel use, deserve reconsideration because emerging evidence suggests ultrasound guidance may reduce complications to an acceptable risk profile.
• Ultrasound-assisted pleuroscopy and ultrasound-guided biopsies performed by experienced users have low complication rates and high diagnostic yield similar to computed tomography-guided biopsies.
Summary
Increased use of ultrasound may be attributed to its portability paired with real-time assessment. Integrating ultrasound guidance with thoracic procedures repeatedly demonstrates reductions in complication rates and is emerging as standard of care.
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References
Papers of particular interest, published recently, have been highlighted as: •Of importance
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Jason McClune and Jose Cardenas-Garcia declare no conflict of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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Key Points
• Ultrasound guidance during thoracic procedures can reduce complications such as bleeding, pneumothorax, and organ perforation, even in high-risk patient populations.
• Ultrasound site-marking techniques achieve high safety and success rates as long as the patient is not repositioned before needle/device insertion.
• Ultrasound-guided biopsies of pleural-based lesions can achieve a higher yield than CT chest guidance due to the ability of ultrasound to differentiate liquid from solid structures.
This article is part of the Topical Collection on Point of Care Thoracic Ultrasound
Electronic Supplementary Material
Video 1
Simple pleural effusion. This video shows a simple left sided pleural effusion. Notice that minimal adjustments in the angulation of the ultrasound probe will show cardiac structures, highlighting the importance of reproducing the angle of the probe with the needle.
Video 2
Pseudopleural effusion. This video shows an anechoic area in the upper part of the screen. Anterior angulation of the probe reveals the presence of the diaphragm and splenorenal recess, confirming ascites.
Video 3
Chest wall rebound. This video shows a thick chest wall in an edematous patient. Notice the effect of the probe pressure over the thickness of the chest wall, varying from 2.5 to 5 cm.
Video 4
Identification of wire within pleural effusion. This video shows the presence of a hyperechoic curvilinear structure within a large pleural effusion representing a wire. At 6 s, another clip shows intentional movement of the wire within a small pleural effusion
Video 5
Identification of chest tube within pleural effusion. This video shows the presence of two parallel hyperechoic lines within a small pleural effusion representing a chest tube. At 6 s, another clip shows a moving “pigtail” catheter.
Video 6
Lung re-expansion after chest tube insertion. This video shows the progression from absence to full presence of lung sliding during the chest tube insertion in a patient with pneumothorax.
Video 7
Identification of intercostal artery with color Doppler. This video shows the identification of an intercostal artery. The initial clip shows an intercostal artery, identified as a pulsatile red area using color Doppler, running just below the rib. At 6 s, another case shows an aberrant intercostal artery located at the upper border of the caudal rib. The operator will either need to direct the needle away from the vessel or select another area of insertion.
Video 8
Pleural effusion with diaphragmatic metastasis. This video shows metastatic mass crossing the diaphragm in malignant pleural effusion. The spleen in observed in the left side of the screen.
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McClune, J., Cardenas-Garcia, J. Ultrasound Guidance for Thoracic Procedures. Curr Pulmonol Rep 6, 187–194 (2017). https://doi.org/10.1007/s13665-017-0188-6
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DOI: https://doi.org/10.1007/s13665-017-0188-6