The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome.
Can ultrasound be of any help in the diagnosis of alveolar-interstitial syndrome? In a prospective study, we examined 250 consecutive patients in a medical intensive care unit: 121 patients with radiologic alveolar-interstitial syndrome (disseminated to the whole lung, n = 92; localized, n = 29) and 129 patients without radiologic evidence of alveolar-interstitial syndrome. The antero-lateral chest wall was examined using ultrasound. The ultrasonic feature of multiple comet-tail artifacts fanning out from the lung surface was investigated. This pattern was present all over the lung surface in 86 of 92 patients with diffuse alveolar-interstitial syndrome (sensitivity of 93.4%). It was absent or confined to the last lateral intercostal space in 120 of 129 patients with normal chest X-ray (specificity of 93.0%). Tomodensitometric correlations showed that the thickened sub-pleural interlobular septa, as well as ground-glass areas, two lesions present in acute pulmonary edema, were associated with the presence of the comet-tail artifact. In conclusion, presence of the comet-tail artifact allowed diagnosis of alveolar-interstitial syndrome.
Lichtenstein
D
D
Service de Réanimation Médicale, Hôpital Ambroise-Paré, Boulogne, Paris, France.
Mézière
G
G
Biderman
P
P
Gepner
A
A
Barré
O
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000000981:diagnostic imaging*; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging; D008875:Middle Aged; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000000981:diagnostic imaging; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography