CHEST Guidelines-The-Best-Approach-for-Detecting-B-Lines

The-Best-Approach-for-Detecting-B-Lines_chest

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In a letter to the editor, Dr. Gino Soldati and colleagues discuss the findings of Dubinsky et al., who correlated B-lines in ultrasound images with interstitial lung disease seen on chest radiographs and CT scans, specifically in postoperative liver transplant patients. They acknowledge the clarity of the methods and validity of the conclusions but express reservations about the use of oblique axial and sagittal subcostal ultrasound views for detecting B-lines. These views involve the ultrasound beam passing through the liver and diaphragm before reaching the pleural surface, which they argue could introduce two issues: attenuation of the ultrasound energy reducing the quality of images and artifacts, and targeting the diaphragmatic pleura which includes basal lung regions often physiologically hypoventilated.<br /><br />The authors suggest that B-lines are sensitive to minimal fluctuations in the subpleural lung tissue air and fluid dynamics. Hence, these can appear even when CT and radiographs do not show abnormalities, particularly post-abdominal surgery or under prolonged supine positions. They emphasize that B-lines and associated 'dirty shadowing' represent a physical state of the lung, potentially misleadingly interpreted as a sign of disease, when they could be merely functional changes enhanced by the subcostal view. This commentary brings awareness to the understanding that these ultrasound findings are a ‘normal variant’, stressing the need for careful interpretation. <br /><br />Dr. Soldati and his colleagues ultimately suggest that such manifestations might not always indicate lung disease, particularly when noted in the examined sonographic views. The response from Dubinsky et al. was not included in this summary but highlights ongoing discussions in the medical field about best practices for lung ultrasound imaging.

Keywords

B-lines

ultrasound

interstitial lung disease

liver transplant

subcostal view

pleural surface

artifacts

diaphragmatic pleura

lung imaging

normal variant