Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)
-
Upload
gamal-agmy -
Category
Documents
-
view
518 -
download
0
Transcript of Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)
![Page 1: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/1.jpg)
![Page 2: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/2.jpg)
Basics of Chest Sonography
and Anatomy of Chest Wall
By
Gamal Rabie Agmy , MD , FCCP Professor of Chest Diseases ,Assiut University
ERS National Delegate of Egypt
![Page 3: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/3.jpg)
![Page 4: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/4.jpg)
• Diagnostic ultrasonography
is the only clinical imaging
technology currently in use
that does not depend on
electromagnetic radiation.
![Page 5: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/5.jpg)
Ultrasound Transducer
Speaker
transmits sound pulses
Microphone
receives echoes
• Acts as both speaker & microphone Emits very short sound pulse
Listens a very long time for returning echoes
• Can only do one at a time
![Page 6: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/6.jpg)
Physical Principles
![Page 7: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/7.jpg)
Cycle • 1 Cycle = 1 repetitive periodic oscillation
Cycle
![Page 8: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/8.jpg)
Frequency
• # of cycles per second
• Measured in Hertz (Hz)
-Human Hearing 20 - 20,000 Hz
-Ultrasound > 20,000 Hz
-Diagnostic Ultrasound 2.5 to 10
MHz
(this is what we use!)
![Page 9: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/9.jpg)
frequency 1 cycle in 1 second = 1Hz
1 second
= 1 Hertz
![Page 10: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/10.jpg)
High Frequency
• High frequency (5-10 MHz)
greater resolution
less penetration
• Shallow structures
vascular, abscess, t/v gyn,
testicular
![Page 11: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/11.jpg)
Low Frequency
• Low frequency (2-3.5 MHz)
greater penetration
less resolution
• Deep structures
Aorta, t/a gyn, card, gb, renal
![Page 12: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/12.jpg)
Wavelength
• The length of one complete cycle
• A measurable distance
![Page 13: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/13.jpg)
Wavelength
Wavelength
![Page 14: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/14.jpg)
Amplitude
• The degree of variance from the normal
Amplitude
![Page 15: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/15.jpg)
The Machine
![Page 16: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/16.jpg)
Ultrasound scanners
• Anatomy of a scanner:
– Transmitter
– Transducer
– Receiver
– Processor
– Display
– Storage
![Page 17: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/17.jpg)
Transmitter
• a crystal makes energy into sound waves and then receives sound waves and converts to energy
• This is the Piezoelectric effect
• u/s machines use time elapsed with a presumed velocity (1,540 m/s) to calculate depth of tissue interface
• Image accuracy is therefore dependent on accuracy of the presumed velocity.
![Page 18: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/18.jpg)
Transducers
• Continuous mode
– continuous alternating current
– doppler or theraputic u/s
– 2 crystals –1 talks, 1 listens
• Pulsed mode
– Diagnostic u/s
– Crystal talks and then listens
![Page 19: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/19.jpg)
Receiver
• Sound waves hit and make voltage
across the crystal-
• The receiver detects and amplifies
these voltages
• Compensates for attenuation
![Page 20: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/20.jpg)
Signal Amplification
• TGC (time gain
compensation)
– Manual control
– Selective enhancement or suppression of sectors of the image
– enhance deep and suppress superficial
*blinders
• Gain
– Manual control
– Affects all parts of the image equally
– Seen as a change in “brightness” of the images on the entire screen
*glasses
![Page 21: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/21.jpg)
Changing the TGC
![Page 22: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/22.jpg)
Changing the Gain
![Page 23: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/23.jpg)
Displays
• B-mode
– Real time gray scale, 2D
– Flip book- 15-60 images per second
• M-mode
– Echo amplitude and position of moving
targets
– Valves, vessels, chambers
![Page 24: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/24.jpg)
“B” Mode
![Page 25: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/25.jpg)
“M” Mode
![Page 26: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/26.jpg)
Image properties
• Echogenicity- amount of energy reflected back from tissue interface
– Hyperechoic - greatest intensity - white
– Anechoic - no signal - black
– Hypoechoic – Intermediate - shades of gray
![Page 27: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/27.jpg)
Hyperechoic
Hypoechoic
Anechoic
![Page 28: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/28.jpg)
Image Resolution
• Image quality is dependent on
– Axial Resolution
– Lateral Resolution
– Focal Zone
– Probe Selection
– Frequency Selection
– Recognition of Artifacts
![Page 29: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/29.jpg)
Axial Resolution
• Ability to differentiate two objects along
the long axis of the ultrasound beam
• Determined by the pulse length • Product of wavelength λ and # of cycles in
pulse
• Decreases as frequency f increases
• Higher frequencies produce better
resolution
![Page 30: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/30.jpg)
Axial Resolution
• 5 MHz transducer
– Wavelength 0.308mm
– Pulse of 3 cycles
– Pulse length
approximately 1mm
– Maximum resolution
distance of two objects
= 1 mm
• 10 MHz transducer
– Wavelength 0.15mm
– Pulse of 3 cycles
– Pulse length
approximately 0.5mm
– Maximum resolution
distance of two objects
= 0.5mm
![Page 31: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/31.jpg)
Axial Resolution
body
screen
![Page 32: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/32.jpg)
Lateral Resolution
• The ultrasound beam is made up of
multiple individual beams
• The individual beams are fused to
appear as one beam
• The distances between the single
beams determines the lateral resolution
![Page 33: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/33.jpg)
Lateral resolution
• Ability to differentiate objects along an
axis perpendicular to the ultrasound
beam
• Dependent on the width of the
ultrasound beam, which can be
controlled by focusing the beam
• Dependent on the distance between the
objects
![Page 34: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/34.jpg)
Lateral Resolution
body
screen
![Page 35: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/35.jpg)
Focal Zone • Objects within the focal zone • Objects outside of focal zone
Focal zone Focal zone
![Page 36: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/36.jpg)
Probe options • Linear Array
• Curved Array
![Page 37: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/37.jpg)
Ultrasound Artifacts
• Can be falsely interpreted as real
pathology
• May obscure pathology
• Important to understand and appreciate
![Page 38: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/38.jpg)
Ultrasound Artifacts
• Acoustic enhancement
• Acoustic shadowing
• Lateral cystic shadowing (edge artifact)
• Wide beam artifact
• Side lobe artifact
• Reverberation artifact
• Gain artifact
• Contact artifact
![Page 39: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/39.jpg)
Acoustic Enhancement
• Opposite of acoustic shadowing
• Better ultrasound transmission allows
enhancement of the ultrasound signal
distal to that region
![Page 40: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/40.jpg)
Acoustic Enhancement
![Page 41: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/41.jpg)
Acoustic Shadowing
• Occurs distal to any highly reflective or
highly attenuating surface
• Important diagnostic clue seen in a
large number of medical conditions
– Biliary stones
– Renal stones
– Tissue calcifications
![Page 42: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/42.jpg)
Acoustic Shadowing
• Shadow may be more prominent than
the object causing it
• Failure to visualize the source of a
shadow is usually caused by the object
being outside the plane of the
ultrasound beam
![Page 43: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/43.jpg)
Acoustic Shadowing
![Page 44: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/44.jpg)
Acoustic Shadowing
![Page 45: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/45.jpg)
Lateral Cystic Shadowing
• A type of refraction artifact
• Can be falsely interpreted as an
acoustic shadow (similar to gallstone)
![Page 46: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/46.jpg)
X
Lateral Cystic Shadowing
![Page 47: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/47.jpg)
Beam-Width Artifact
• Gas bubbles in the duodenum can
simulate a gall stone
• Does not assume a dependent posture
• Do not conform precisely to the walls of
the gallbladder
![Page 48: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/48.jpg)
Beam-Width Artifact
Beam-width artifact Gas in the duodenum simulating stones
![Page 49: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/49.jpg)
Side Lobe Artifact
• More than one ultrasound beam is
generated at the transducer head
• The beams other than the central axis
beam are referred to as side lobes
• Side lobes are of low intensity
![Page 50: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/50.jpg)
Side Lobe Artifact
• Occasionally cause
artifacts
• The artifact by be
obviated by
alternating the angle
of the transducer
head
![Page 51: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/51.jpg)
Side Lobe Artifact
![Page 52: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/52.jpg)
Reverberation Artifacts
• Several types
• Caused by the echo bouncing back and
forth between two or more highly
reflective surfaces
![Page 53: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/53.jpg)
Reverberation Artifacts
• On the monitor parallel bands of
reverberation echoes are seen
• This causes a “comet-tail” pattern
• Common reflective layers
– Abdominal wall
– Foreign bodies
– Gas
![Page 54: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/54.jpg)
Reverberation Artifacts
![Page 55: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/55.jpg)
Reverberation Artifacts
![Page 56: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/56.jpg)
Gain Artifact
![Page 57: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/57.jpg)
Contact artifact
• Caused by poor probe-
patient interface
![Page 58: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/58.jpg)
![Page 59: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/59.jpg)
Traditionally, air has been considered the
enemy of ultrasound and the lung has been
considered an organ not amenable to
ultrasonographic examination. Visualizing the
lung is essential to treating patients who are
critically ill.
![Page 60: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/60.jpg)
![Page 61: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/61.jpg)
![Page 62: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/62.jpg)
![Page 63: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/63.jpg)
Lines written on ultrasound in the five
Light’s editions
43
78
102
122
278
1983 1990 1995 2001 2008
![Page 64: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/64.jpg)
1998 -2008
![Page 65: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/65.jpg)
2009
![Page 66: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/66.jpg)
2010
V SCAN
![Page 67: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/67.jpg)
Probes
![Page 68: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/68.jpg)
A high-resolution linear transducer of 5–10 MHz is suitable for imaging the thorax wall and the parietal pleura (Mathis 2004). More recently introduced probes of 10–13 MHz are excellent for evaluating lymph nodes (Gritzmann 2005), pleura and the surface of the lung.
For investigation of the lung a convex or sector probe
of 3–5 MHz provides adequate depth of penetration.
![Page 69: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/69.jpg)
Transthoracic Sonography
![Page 70: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/70.jpg)
![Page 71: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/71.jpg)
Scanning Positions for Chest Sonography
![Page 72: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/72.jpg)
![Page 74: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/74.jpg)
![Page 75: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/75.jpg)
Normal Anatomy
![Page 76: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/76.jpg)
![Page 77: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/77.jpg)
Normal lung surface
Left panel: Pleural line and A line (real-time). The pleural line is located 0.5 cm below the rib line in the adult. Its visible length between two ribs in the longitudinal scan is approximately 2 cm. The upper rib, pleural line, and lower rib (vertical arrows) outline a characteristic pattern called the bat sign.
![Page 79: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/79.jpg)
Normal Chest Ultrasound
Superficial tissues
ribs
Poste
rior a
coustic
shadow
ing
Impure
acoustic
shadow
ing
Pleural line
Muscle
Fat
Pleura
Lung
![Page 81: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/81.jpg)
![Page 82: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/82.jpg)
![Page 83: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/83.jpg)
![Page 86: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/86.jpg)
![Page 87: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/87.jpg)
the "seashore sign" (Fig.3).
![Page 88: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/88.jpg)
![Page 89: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/89.jpg)
![Page 90: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/90.jpg)
![Page 91: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/91.jpg)
![Page 92: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/92.jpg)
![Page 93: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/93.jpg)
![Page 94: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/94.jpg)
![Page 95: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/95.jpg)
Duplex Doppler sonogram of a 5 x 3 cm hypoechoic mass
(adenocarcinoma) in upper lobe of left lung shows blood flow
at margin of tumor near pleura. Spectral waveform reveals
arteriovenous shunting: low-impedance flow with high
systolic and diastolic velocities. Pulsatility index = 0.90,
resistive index = 0.51, peak systolic velocity = 0.47 m/sec, end
diastolic velocity =0.23 m/sec, peak frequency shift = 3.8 kHz,
![Page 96: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/96.jpg)
Duplex Doppler sonogram in 67-year-old man with pulmonary
tuberculosis in lower lobe of left lung shows several blue and
red flow signals in massiike lesion. Spectral waveform reveals
high-impedance flow. Pulsetility index = 4.20, resistive index =
0.93, peak systolic velocity = 0.45 m/sec, end diastolic
velocity = 0.03 m/sec, Doppler angle = 21#{
![Page 97: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/97.jpg)
Alveolar-interstitial
syndrome
![Page 98: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/98.jpg)
![Page 99: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/99.jpg)
![Page 100: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/100.jpg)
![Page 101: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/101.jpg)
![Page 102: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/102.jpg)
![Page 103: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/103.jpg)
![Page 104: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/104.jpg)
![Page 105: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/105.jpg)
![Page 106: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/106.jpg)
(Chest. 2008; 133:836-837)
© 2008 American College of Chest
Physicians
Ultrasound: The Pulmonologist’s New
Best Friend
Momen M. Wahidi, MD, FCCP
Durham, NC
Director, Interventional Pulmonology, Duke
University Medical Center, Box 3683,
Durham, NC 27710
![Page 107: Sudanese Chest Sonography Workshop (Basics of sonography and anatomy of chest wall)](https://reader030.fdocuments.net/reader030/viewer/2022032615/55a2d96c1a28ab887d8b4760/html5/thumbnails/107.jpg)