The 'cardiac-lung mass' artifact: an echocardiographic sign of lung atelectasis and/or pleural effusion.
BACKGROUND
We conducted an ultrasound study to investigate echocardiographic artifacts in mechanically ventilated patients with lung pathology.


METHODS
A total of 205 mechanically ventilated patients who exhibited lung atelectasis and/or pleural effusion were included in this 36-month study. The patients underwent lung echography and transthoracic echocardiography, with a linear 5 to 10 MHz and with a 1.5 to 3.6 MHz wide-angle phased-array transducer, respectively. Patients were examined by two experienced observers who were blinded to each other's interpretation.


RESULTS
A total of 124 patients (60,48%) were hospitalized because of multiple trauma; 60 patients (29,26%) because of respiratory insufficiency, and 21 (10,24%) because of recent postoperative surgery. The mean duration ( +/- standard deviation) of hospitalization was 35 +/- 27 days. An intracardiac artifact was documented in 17 out of 205 patients (8.29%) by echocardiography. It was visible only in the apical views, whereas subsequent transesophageal echocardiography revealed no abnormalities. The artifact consisted of a mobile component that exhibited, on M-mode, a pattern of respiratory variation similar to the lung 'sinusoid sign'. Lung echography revealed lung atelectasis and/or pleural effusion adjacent to the heart, and a similar M-mode pattern was observed. The artifact was recorded within the left cardiac chambers in 11 cases and within the right cardiac chambers in six.


CONCLUSIONS
Lung atelectasis and/or pleural effusion may create a mirror image, intracardiac artifact in mechanically ventilated patients. The latter was named the 'cardiac-lung mass' artifact to underline the important diagnostic role of both echocardiography and lung echography in these patients.


BACKGROUND
This trial is ISRCTN registered: ISRCTN 49216096.
Karabinis
Andreas
A
Department of Intensive Care Medicine, General Hospital of Athens, Mesogeion Avenue, Athens, 115 27, Greece. echolabicu@gmail.com
Saranteas
Theodosios
T
Karakitsos
Dimitrios
D
Lichtenstein
Daniel
D
Poularas
John
J
Yang
Clifford
C
Stefanadis
Christodoulos
C
D000328:Adult; D000368:Aged; D016477:Artifacts; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000209:etiology; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging* / Q000209:etiology; D012121:Respiration, Artificial / Q000009:adverse effects; D055815:Young Adult