Ultrasound in Diagnosis of Pulmonary Congestion in Patients with Heart Failure.

Abstract

Pulmonary congestion and Oedema is useful marker of HF, but its diagnosis is chalenging. The aim of this study was to determine the place of pulmonary ultrasound in patients with DHF.

Objective: To find Sonographic changes of lung in patients with Congestive Heart Failure, and to find Sonographic signs of pulmonary edema and congestion in patients with Congestive Heart Failure.

Material and Method: We studied 280 patients with heart diseases who had different grade CHF (100 – female, 180 – male; mean age 62,6±9,7 year). A control group: 80 normal persons, patients with arterial hypertension or stable angina (32 – female, 48 – male; mean age 63,6±9,8 year), who had no signs of heart failure. No one in HF or control group had any signs of pulmonary diseases and became any treatment before examination. The transthoracic ultrasound examination was performed with 3 – 3,5 MHz sector and 3,5 – 4 MHz convex transducer. The patients were examined in vertical (seated) or horizontal (lying) position,  from 10 points of thoracic wall which corresponded to the projection of lower, middle and upper lobes of a right lung and upper and lower lobes of left lung.

Results: The normal ultrasound lung pattern is characte-rized by, parallel lines or there are irregular reflections on screen. In patients with CHF we significantly often found the one of the sorts of reverberation phenomenon - "Comet tail Phenomenon" (CTPh) (97,5% versus 41,25% in control, p<0,005). The comet-tail phenomenon was defined as a hyper-echogenic narrow-based reverberation type of artifact, spreading from the visceral pleura to the distal edge of the screen . In patients with CHF we significantly often found the one of the sorts of reverberation phenomenon - "Comet tail Phenomenon" (CTPh) (97,5% versus 41,25% in control, p<0,005). The comet-tail phenomenon was defined as a hyper-echogenic narrow-based reverberation type of artifact, spreading from the visceral pleura to the distal edge of the screen.

Conclusion: Thoracic US is sensitive and accurate method for evaluation pulmonary congestion/oedema in patients with CHF. The US sign of pulmonary congestion in HF is a "Comet tail phenomenon", which is protracted, prominent, multiple and registered from larger area of thoracic wall (4 points or more).