CHEST Guidelines-Response_chest

Response_chest_15 (1)

Pdf Summary

The letter by Gino Soldati, Andrea Smargiassi, Alberto Aldo Mariani, and Riccardo Inchingolo critiques the methodology used in a study by Dubinsky et al., which associates B-lines seen in ultrasound with lung conditions in liver transplant patients. The authors question the use of oblique axial and sagittal subcostal ultrasound views, arguing that the method involves limitations such as signal attenuation due to passing through the liver and diaphragm, potentially generating artifacts. Additionally, they highlight concerns about artifacts appearing on diaphragm pleura scans that cover lung areas prone to hypoventilation. They emphasize that B-lines are sensitive to minimal variations in subpleural lung tissue and argue that they often indicate functional changes rather than disease, especially in post-abdominal surgery patients.<br /><br />In his response, Theodore J. Dubinsky defends their approach, explaining the selection of transducer types that penetrate deeper, making B-lines visible regardless of depth. He acknowledges the possibility of mild atelectasis in lung bases and discusses grading B-lines to differentiate normal variants from pathological conditions. Dubinsky agrees that ultrasound might surpass chest radiographs in detecting surface airspace disease but notes the difficulty in researching this due to the challenges in finding patients with simultaneous contradictory imaging results.<br /><br />In a different letter, authors applaud CHEST for promoting education-focused articles, stressing the significance of teaching during medical fellowships. They argue that teaching solidifies knowledge, helps identify knowledge gaps, and combats burnout, encouraging fellows to engage in educational roles to become effective educators in their medical specialties.

Keywords

ultrasound

B-lines

lung conditions

liver transplant

signal attenuation

artifacts

hypoventilation

atelectasis

medical education

fellowships