Ultrasound diagnosis of alveolar consolidation in the critically ill.
OBJECTIVE
Alveolar consolidation is a basic concern in critically ill patients. Radiography is not a precise tool, and referral to CT raises problems (transport, irradiation). The aim of this study was to assess the utility of ultrasound in the diagnosis of alveolar consolidation.


METHODS
Prospective clinical study.


METHODS
The medical ICU of a university-affiliated teaching hospital.


METHODS
A total of 65 cases of alveolar consolidation proven on CT were compared to 53 CT controls.


METHODS
Alveolar consolidation was defined as a tissue-like pattern visible at the chest wall, arising from the pleural line and devoid of centrifugal inspiratory dynamics.


RESULTS
Feasibility was 99%. In 65 cases of alveolar consolidation, ultrasound was positive in 59 and negative in 6. In 52 analyzable controls, ultrasound was negative in 51 and positive in 1. Sensitivity of ultrasound was 90% and specificity 98%. A concordance test showed a Kappa coefficient of 0.89. Among 62 posterior locations on CT, ultrasound showed posterior consolidation patterns in 56 cases and was negative in 6. Ultrasound showed anterior involvement in all 3 cases of whole lung consolidation.


CONCLUSIONS
Ultrasound provides a reliable non-invasive, bedside method for accurate detection and location of alveolar consolidation in critically ill patients.
Lichtenstein
Daniel A
DA
Service de Réanimation Médicale, Hôpital Ambroise-Paré, 9 avenue du Général Charles-de-Gaulle, 92100 , Boulogne (Paris-Ouest), France. dlicht@free.fr.|Cercle des Echographistes d'Urgence et de Réanimation Francophones, 14 rue Alfred Couturier, 78160 , Marly, France. dlicht@free.fr.|Service de Réanimation Polyvalente, Centre Hospitalier Général, 92210 , Saint-Cloud (Paris), France. dlicht@free.fr.
Lascols
Nathalie
N
Cercle des Echographistes d'Urgence et de Réanimation Francophones, 14 rue Alfred Couturier, 78160 , Marly, France.
Mezière
Gilbert
G
Service de Réanimation Médicale, Hôpital Ambroise-Paré, 9 avenue du Général Charles-de-Gaulle, 92100 , Boulogne (Paris-Ouest), France.|Cercle des Echographistes d'Urgence et de Réanimation Francophones, 14 rue Alfred Couturier, 78160 , Marly, France.|Service de Réanimation Polyvalente, Centre Hospitalier Général, 92210 , Saint-Cloud (Paris), France.
Gepner
Agnès
A
Service de Réanimation Polyvalente, Centre Hospitalier Général, 92210 , Saint-Cloud (Paris), France.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography