CHEST Guidelines-Current-Misconceptions-in-Lung-Ultrasound_2019

Current-Misconceptions-in-Lung-Ultrasound_2019_che

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The article "Current Misconceptions in Lung Ultrasound" by Dr. Daniel A. Lichtenstein addresses misconceptions in lung ultrasound, particularly within critically ill contexts (LUCI). Lichtenstein emphasizes the evolution of lung ultrasound since the early 1990s when it was initially considered impossible. While now widely used across various medical specialties, many practitioners may overestimate its capabilities, believing it can diagnose all conditions accurately. He urges experts to distinguish between conditions detectable via ultrasound, like interstitial syndrome, and those requiring advanced diagnostics, such as high-resolution CT scans.<br /><br />Dr. Lichtenstein clarifies misunderstandings about ultrasound artifacts, particularly the misinterpretation of comet-tail artifacts. He refines definitions, such as interstitial syndrome, which is often incorrectly described as having more than three B lines between ribs; the accurate number is more than two. Moreover, he advises against using radiologic terms like "alveolar-interstitial syndrome" in ultrasound contexts, advocating for terms like "septal rockets" and "glass rockets" to describe lung conditions accurately.<br /><br />He points out that lung consolidations are multifaceted and not solely indicative of pneumonia but can result from various conditions like pulmonary embolism or atelectasis. The BLUE protocol is promoted as a tool for diagnosing acute respiratory conditions, with emphasis on understanding the semiology of B lines and lung profiles like B and B’ profiles.<br /><br />Lichtenstein critiques the use of certain terminologies and conventions, urging uniformity to prevent confusion. For example, he suggests using "lung sliding" instead of "pleural sliding" and avoiding terms like "barcode sign" due to potential misinterpretations. In terms of equipment, he advocates for simpler, versatile devices, emphasizing their efficacy in critical care.<br /><br />In conclusion, Lichtenstein's commentary is directed at improving the application of lung ultrasound among professionals, ensuring clarity and precision in diagnostics for the benefit of patient care.

Keywords

lung ultrasound

misconceptions

Daniel A. Lichtenstein

interstitial syndrome

comet-tail artifacts

BLUE protocol

B lines

lung consolidations

diagnostic clarity

critical care