Ultralydsscanning af Lunger

Transkript

1 Ultralydsscanning af Lunger

2 Ultralydsscanning af lunger Personlig baggrund Ultralydsscanning af lunger - baggrund Pneumothorax Interstitielt syndrom Perspektiv

3 Ultralydsscanning af lunger - baggrund Ultrasound imaging is not useful for evaluation of the pulmonary parenchyma TR Harrison, Principles of Internal Medicine The utility of thoracic ultrasound for diagnosing a pneumothorax is limited in hospital practice due to the ready availability of chest x-rays (CXR) and conflicting data from published reports - Havelock T, Teoh R, Laws D, et al. Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline Thorax 2010;65

4 Ultralydsscanning af lunger - baggrund Historie: - Dénier A. Les ultrasons, leur application au diagnostic. Presse Méd 1946;22: Joyner C, Miller LD, Dudrick SJ et al. Reflected ultrasound in the detection of pulmonary embolism. Trans Assn Am Phys 1966;79: Rantanen NW. Diseases of the thorax. Vet Clin North Am Equine Pract Apr;2(1): Dorne HL. Differentiation of pulmonary parenchymal consolidation from pleural disease using the sonographic fluid bronchogram. Radiology Jan;158(1): Lichtenstein D, Mezière G, Biderman P, Gepner A, Barré O. The Comet-tail Artifact. An Ultrasound Sign of Alveolar-Interstitial Syndrome. Am J Respir Crit Care Med 1997;156: Kirkpatrick AW, Nicolaou S, Rowan K. Thoracic sonography for pneumothorax: the clinical evaluation of an operational space medicine spin-off. Acta Astronaut May-Jun;56(9-12):831-8

5 Ultralydsscanning af lunger - baggrund 4 Lungeultralydsskoler: - Den franske - Den germanske - Den italienske - Den nordamerikanske

6 Den franske skole Intensiv patienter: - Pneumothorax - KOL vs lungeødem - ARDS - Atelektase / konsolidering - Fejlintubation - Pneumoni - Lungeemboli - Effusion - Nomenklatur ala France

7 Den germanske skole Lungemedicinske patienter: - Lungeemboli - Pneumoni - CEUS

8 Den italienske skole Kardiologiske patienter: - Lungeødem/stase - Brystsmerter - Interstitielle lungesygdomme - Pædiatri

9 Den nordamerikanske skole Traumatologi / wilderness: - Pneumothorax - Højde syge - NASA

10 Den danske skole? Ugeskr Læger 2009;171(36):2541: LUS hos den kritisk syge patient. I gang værende projekter: - Skejby: Størrelse af pneumothorax, FATE - OUH: Afd J /AMA / SDU

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12 Konsensus Rapport 2011? - Pneumothorax - KOL / astma - ARDS - Atelektase / konsolidering - Fejlintubation - Effusion - Pneumoni - Lungeemboli - Lungeødem/stase - Brystsmerter - Interstitielle lungesygdomme

13 Ultralydsscanning af lunger Personlig baggrund Ultralydsscanning af lunger - baggrund Pneumothorax Interstitielt syndrom Perspektiv

14 Pneumothorax Key signs ved pneumothorax diagnostik: - Lungsliding - A-linjer - B-linjer - Lung point - Lung pulse

15 Pneumothorax Key signs ved pneumothorax diagnostik: - Lungsliding (rule-out) - A-linjer (uspecifikt) - B-linjer (rule-out) - Lung point (rule-in) - Lung pulse (rule-out)

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17 Pneumothorax Lungsliding Lichtenstein et al. Chest 1995;108:

18 Pneumothorax Lungsliding: - M-mode: Seashore sign Lichtenstein et al. Chest 1995;108:

19 Pneumothorax Ingen lungsliding: - Tydelige A-linjer - M-mode: Stratosfere sign Lichtenstein et al. Chest 1995;108:

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22 Lichtenstein et al. Intensive Care Med 2000;26: Lung Point

23 Lichtenstein et al. Intensive Care Med 2000;26: Lung Point

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25 Lung Pulse Pneumothorax eller fejlintubation? Lichtenstein et al. Intensive Care Med 2003;29:

26 Lichtenstein et al. Intensive Care Med 2003;29: Lung Pulse

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28 Pneumothorax Chest Sonography EFSUMB European course book.

29 Ultralydsscanning af lunger Personlig baggrund Ultralydsscanning af lunger - baggrund Pneumothorax Interstitielt syndrom Perspektiv

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31 Interstitielt syndrom Lichtenstein et al. Am J Respir Crit Care Med 1997;156:

32 Interstitielt syndrom Lichtenstein et al. Am J Respir Crit Care Med 1997;156:

33 Interstitielt syndrom Lichtenstein et al. Am J Respir Crit Care Med 1997;156:

34 Interstitielt syndrom Lichtenstein et al. Am J Respir Crit Care Med 1997;156:

35 Interstitielt syndrom Lichtenstein et al. Am J Respir Crit Care Med 1997;156:

36 Interstitielt syndrom Sensitivitet: 93,4% Specificitet: 93,0% Lichtenstein et al. Am J Respir Crit Care Med 1997;156:

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38 Lichtenstein et al. Int Care Med 1998;24: Interstitielt syndrom

39 Lichtenstein et al. Int Care Med 1998;24: Interstitielt syndrom

40 Ultralydsscanning af lunger Personlig baggrund Ultralydsscanning af lunger - baggrund Pneumothorax Interstitielt syndrom Perspektiv

41 Ultralydsscanning af lunger Personlig baggrund Ultralydsscanning af lunger - baggrund Pneumothorax Interstitielt syndrom Perspektiv: - Diagnostik - Follow up

42 Ultralydsscanning af lunger Personlig baggrund Ultralydsscanning af lunger - baggrund Pneumothorax Interstitielt syndrom Perspektiv: - Diagnostik - Follow up

43 Diagnostisk Lungeultralyd Reissig et al. Pneumonologie 2007;61:20-40

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45 Mathis et al. Chest 2005;128: Lungeinfarkt

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48 Lichtenstein et al. Chest 2008;134:

49 Lichtenstein et al. Chest 2008;134:

50 Lichtenstein et al. Chest 2008;134:

51 Reissig et al. Pneumonologie 2007;61:20-40

52 Ultralydsscanning af lunger Personlig baggrund Ultralydsscanning af lunger - baggrund Pneumothorax Interstitielt syndrom Perspektiv: - Diagnostik - Follow up

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55 Lekture

56 Europæiske Kurser WinFocus Certified Course in Emergency Lung Ultrasound (16-17 Maj, Skejby) WinFocus Scandinavia (10-12 November, Skejby) ÖGUM Euroson School (23-24 September 2011, Prag)