Ультразвуковое исследование легких: новые возможности для кардиолога

Обзор литературы посвящен ультразвуковому исследованию (УЗИ) легких, которое является полезным дополнением к трансторакальной эхокардиографии (ЭхоКГ) и по диагностической ценности превосходит рентгенографию органов грудной клетки. Акустическое легочное окно остается всегда открытым и в большинстве случаев позволяет получить изображения высокого качества. Для кардиолога основные точки приложения метода – это определение плеврального выпота и легочного застоя. Метод обладает рядом преимуществ: не занимает много времени, имеет низкую стоимость, портативность и доступность, возможность обследования в режиме реального времени, отсутствие радиации, хорошую воспроизводимость и высокую информативность. Обнаружение «влажных» легких при УЗИ легких свидетельствует об угрожающей острой декомпенсации сердца еще задолго до появления клинических, аускультативных и рентгенологических признаков легочного застоя. Современная ЭхоКГ должна включать обследование сердца и легких в рамках одного интегрированного УЗИ.

1. Harrison’s principles of internal medicine. Longo DL, Fauci AS, Kasper DL, Jameson JL, Hauser SL, Loscalzo J, editors -New York, NY: McGraw-Hill Medical;2011. -4012 p. [Part 11, Section 1, Chapter 253]. ISBN 978-0-07-174889-6

2. Скородумова Е.Г., Костенко В.А., Скородумова Е.А., Сиверина А.В. Оценка интерстициального отека у пациентов с промежуточной функцией левого желудочка после купирования острой декомпенсации сердечной недостаточности. Трансляционная медицина. 2018;5(3):23-7. DOI: 10.18705/2311-4495-2018-5-3-23-27

3. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Medicine. 2012;38(4):577–91. DOI: 10.1007/s00134-012-2513-4

4. Picano E, Frassi F, Agricola E, Gligorova S, Gargani L, Mottola G. Ultrasound Lung Comets: A Clinically Useful Sign of Extravascular Lung Water. Journal of the American Society of Echocardiography. 2006;19(3):356–63. DOI: 10.1016/j.echo.2005.05.019

5. Gargani L. Lung ultrasound: a new tool for the cardiologist. Cardiovascular Ultrasound. 2011;9(1):6. DOI: 10.1186/1476-7120-9-6

6. Алехин М.Н. Ультразвуковое исследование легких для диагностики внесосудистой жидкости. Креативная кардиология. 2015;1:27-37

7. Lichtenstein DA. Lung ultrasound in the critically ill. Annals of Intensive Care. 2014;4(1):1. DOI: 10.1186/2110-5820-4-1

8. Frassi F, Gargani L, Gligorova S, Ciampi Q, Mottola G, Picano E. Clinical and echocardiographic determinants of ultrasound lung comets. European Journal of Echocardiography. 2007;8(6):474–9. DOI: 10.1016/j.euje.2006.09.004

9. Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Margonato A et al. “Ultrasound Comet-Tail Images”: A Marker Of Pulmonary Edema: a comparative study with wedge pressure and extravascular lung water. Chest. 2005;127(5):1690–5. DOI: 10.1378/chest.127.5.1690

10. Volpicelli G, Melniker LA, Cardinale L, Lamorte A, Frascisco MF. Lung ultrasound in diagnosing and monitoring pulmonary interstitial fluid. La radiologia medica. 2013;118(2):196–205. DOI: 10.1007/s11547-012-0852-4

11. Cortellaro F, Ceriani E, Spinelli M, Campanella C, Bossi I, Coen D et al. Lung ultrasound for monitoring cardiogenic pulmonary edema. Internal and Emergency Medicine. 2017;12(7):1011–7. DOI: 10.1007/s11739-016-1510-y

12. Baldi G, Gargani L, Abramo A, D’Errico L, Caramella D, Picano E et al. Lung water assessment by lung ultrasonography in intensive care: a pilot study. Intensive Care Medicine. 2013;39(1):74–84. DOI: 10.1007/s00134-012-2694-x

13. Gargani L, Volpicelli G. How I do it: Lung ultrasound. Cardiovascular Ultrasound. 2014;12(1):25. DOI: 10.1186/1476-7120-12-25

14. Ziskin MC, Thickman DI, Goldenberg NJ, Lapayowker MS, Becker JM. The comet tail artifact. Journal of Ultrasound in Medicine. 1982;1(1):1–7. DOI: 10.7863/jum.1982.1.1.1

15. Thickman DI, Ziskin MC, Goldenberg NJ, Linder BE. Clinical manifestations of the comet tail artifact. Journal of Ultrasound in Medicine. 1983;2(5):225–30. DOI: 10.7863/jum.1983.2.5.225

16. Targhetta R, Chavagneux R, Balmes P, Lemerre C, Mauboussin JM, Bourgeois JM et al. Sonographic lung surface evaluation in pulmonary sarcoidosis: preliminary results. Journal of Ultrasound in Medicine. 1994;13(5):381–8. DOI: 10.7863/jum.1994.13.5.381

17. Picano E, Pellikka PA. Ultrasound of extravascular lung water: a new standard for pulmonary congestion. European Heart Journal. 2016;37(27):2097–104. DOI: 10.1093/eurheartj/ehw164

18. Jambrik Z, Monti S, Coppola V, Agricola E, Mottola G, Miniati M et al. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. The American Journal of Cardiology. 2004;93(10):1265–70. DOI: 10.1016/j.amjcard.2004.02.012

19. Gargani L, Lionetti V, Di Cristofano C, Bevilacqua G, Recchia FA, Picano E. Early detection of acute lung injury uncoupled to hypoxemia in pigs using ultrasound lung comets. Critical Care Medicine. 2007;35(12):2769–74. DOI: 10.1097/01.CCM.0000287525.03140.3F

20. Кобалава Ж.Д., Сафарова А.Ф., Соловьева А.E., Кабельо Ф.Е., Мерай И.А., Шаварова Е.К. и др. Легочный застой по данным ультразвукового исследования у пациентов с декомпенсацией сердечной недостаточности. Кардиология. 2019;59(8):5-14]. DOI: 10.18087/cardio.2019.8.n534

21. Gargani L, Frassi F, Soldati G, Tesorio P, Gheorghiade M, Picano E. Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: A comparison with natriuretic peptides. European Journal of Heart Failure. 2008;10(1):70–7. DOI: 10.1016/j.ejheart.2007.10.009

22. Volpicelli G, Caramello V, Cardinale L, Mussa A, Bar F, Frascisco MF. Bedside ultrasound of the lung for the monitoring of acute decompensated heart failure. The American Journal of Emergency Medicine. 2008;26(5):585–91. DOI: 10.1016/j.ajem.2007.09.014

23. Гришин А.М., Алехин М.Н., Сидоренко Б.А. Опыт использования ультразвукового исследования для выявления внесосудистой жидкости в легких у больных с сердечной недостаточностью. Терапевтический Архив. 2010;82(4):35-9

24. Miglioranza MH, Sousa ACS, Araujo C de SC, Almeida-Santos MA, Gargani L. Lung Ultrasound: The Cardiologists’ New Friend. Arquivos Brasileiros de Cardiologia. 2017;109(6):606–8. DOI: 10.5935/abc.20170169

25. Picano E, Scali MC, Ciampi Q, Lichtenstein D. Lung Ultrasound for the Cardiologist. JACC: Cardiovascular Imaging. 2018;11(11):1692– 705. DOI: 10.1016/j.jcmg.2018.06.023

26. Volpicelli G. Lung Ultrasound in Pneumothorax: The Continuing Need for Appropriate Use and Correct Interpretation. The Journal of Emergency Medicine. 2017;53(2):e25–6. DOI: 10.1016/j.jemermed.2017.03.048

27. Gargani L. Ultrasound of the Lungs More than a Room with a View. Heart Failure Clinics. 2019;15(2):297–303. DOI: 10.1016/j.hfc.2018.12.010

28. Bianco F, Bucciarelli V, Ricci F, De Caterina R, Gallina S. Lung ultrasonography: a practical guide for cardiologists. Journal of Cardiovascular Medicine. 2017;18(7):501–9. DOI: 10.2459/JCM.0000000000000515

29. Volpicelli G, Mussa A, Garofalo G, Cardinale L, Casoli G, Perotto F et al. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. The American Journal of Emergency Medicine. 2006;24(6):689–96. DOI: 10.1016/j.ajem.2006.02.013

30. Volpicelli G, Noble VE, Liteplo A, Cardinale L. Decreased sensitivity of lung ultrasound limited to the anterior chest in emergency department diagnosis of cardiogenic pulmonary edema: a retrospective analysis. Critical Ultrasound Journal. 2010;2(2):47–52. DOI: 10.1007/s13089-010-0037-0

31. Maskell NA. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax. 2003;58(Suppl 2):8ii–17. DOI: 10.1136/thorax.58.suppl_2.ii8

32. Brogi E, Bignami E, Sidoti A, Shawar M, Gargani L, Vetrugno L et al. Could the use of bedside lung ultrasound reduce the number of chest x-rays in the intensive care unit? Cardiovascular Ultrasound. 2017;15(1):23. DOI: 10.1186/s12947-017-0113-8

33. Neskovic AN, Skinner H, Price S, Via G, De Hert S, Stankovic I et al. Focus cardiac ultrasound core curriculum and core syllabus of the European Association of Cardiovascular Imaging. European Heart Journal Cardiovascular Imaging. 2018;19(5):475–81. DOI: 10.1093/ehjci/jey006

34. Diaz-Gomez JL, Ripoll JG, Ratzlaff RA, Tavazzi G. Perioperative Lung Ultrasound for the Cardiothoracic Anesthesiologist: Emerging Importance and Clinical Applications. Journal of Cardiothoracic and Vascular Anesthesia. 2017;31(2):610–25. DOI: 10.1053/j.jvca.2016.11.031

35. Picano E, Scali MC. The lung water cascade in heart failure. Echocardiography. 2017;34(10):1503–7. DOI: 10.1111/echo.13657

36. Lichtenstein D, van Hooland S, Elbers P, Malbrain MLNG. Ten good reasons to practice ultrasound in critical care. Anaesthesiology Intensive Therapy. 2014;46(5):323–35. DOI: 10.5603/AIT.2014.0056

37. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129–200. DOI: 10.1093/eurheartj/ehw128

38. McMurray JJV, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2012;33(14):1787–847. DOI: 10.1093/eurheartj/ehs104

39. Cardinale L. Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure. World Journal of Radiology. 2014;6(6):230–7. DOI: 10.4329/wjr.v6.i6.230

40. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. Journal of the American College of Cardiology. 2009;53(15):e1–90. DOI: 10.1016/j.jacc.2008.11.013

41. Volpicelli G. Lung Sonography. Journal of Ultrasound in Medicine. 2013;32(1):165–71. DOI: 10.7863/jum.2013.32.1.165

42. Gargani L, Picano E. The risk of cumulative radiation exposure in chest imaging and the advantage of bedside ultrasound. Critical Ultrasound Journal. 2015;7(1):4. DOI: 10.1186/s13089-015-0020-x

43. Picano E, Gargani L. Ultrasound lung comets: the shape of lung water. European Journal of Heart Failure. 2012;14(11):1194–6. DOI: 10.1093/eurjhf/hfs157

44. Volpicelli G, Cardinale L, Garofalo G, Veltri A. Usefulness of lung ultrasound in the bedside distinction between pulmonary edema and exacerbation of COPD. Emergency Radiology. 2008;15(3):145–51. DOI: 10.1007/s10140-008-0701-x

45. Dietrich CF, Mathis G, Blaivas M, Volpicelli G, Seibel A, Atkinson NS et al. Lung artefacts and their use. Medical Ultrasonography. 2016;18(4):488–99. DOI: 10.11152/mu-878

46. Picano E, Ciampi Q, Citro R, D’Andrea A, Scali MC, Cortigiani L et al. Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease. Cardiovascular Ultrasound. 2017;15(1):3. DOI: 10.1186/s12947-016-0092-1

47. Scali MC, Ciampi Q, Picano E, Bossone E, Ferrara F, Citro R et al. Quality control of B-lines analysis in stress Echo 2020. Cardiovascular Ultrasound. 2018;16(1):20. DOI: 10.1186/s12947-018-0138-7

48. Picano E, Gargani L, Gheorghiade M. Why, when, and how to assess pulmonary congestion in heart failure: pathophysiological, clinical, and methodological implications. Heart Failure Reviews. 2010;15(1):63–72. DOI: 10.1007/s10741-009-9148-8

49. Torino C, Gargani L, Sicari R, Letachowicz K, Ekart R, Fliser D et al. The Agreement between Auscultation and Lung Ultrasound in Hemodialysis Patients: The LUST Study. Clinical Journal of the American Society of Nephrology. 2016;11(11):2005–11. DOI: 10.2215/CJN.03890416

50. Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung Ultrasound for Critically Ill Patients. American Journal of Respiratory and Critical Care Medicine. 2019;199(6):701–14. DOI: 10.1164/rccm.201802-0236CI

51. Bedetti G, Gargani L, Corbisiero A, Frassi F, Poggianti E, Mottola G. Evaluation of ultrasound lung comets by hand-held echocardiography. Cardiovascular Ultrasound. 2006;4(1):34. DOI: 10.1186/1476-7120-4-34

52. Gargani L, Pang PS, Frassi F, Miglioranza MH, Dini FL, Landi P et al. Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study. Cardiovascular Ultrasound. 2015;13(1):40. DOI: 10.1186/s12947-015-0033-4

53. Coiro S, Rossignol P, Ambrosio G, Carluccio E, Alunni G, Murrone A et al. Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure: Prognostic value of B-lines after discharge from HF hospitalisation. European Journal of Heart Failure. 2015;17(11):1172–81. DOI: 10.1002/ejhf.344

54. Gargani L. Prognosis in heart failure: look at the lungs. European Journal of Heart Failure. 2015;17(11):1086–8. DOI: 10.1002/ejhf.423

55. Cogliati C, Casazza G, Ceriani E, Torzillo D, Furlotti S, Bossi I et al. Lung ultrasound and short-term prognosis in heart failure patients. International Journal of Cardiology. 2016;218:104–8. DOI: 10.1016/j.ijcard.2016.05.010

56. Miglioranza MH, Picano E, Badano LP, Sant’Anna R, Rover M, Zaffaroni F et al. Pulmonary congestion evaluated by lung ultrasound predicts decompensation in heart failure outpatients. International Journal of Cardiology. 2017;240:271–8. DOI: 10.1016/j.ijcard.2017.02.150

57. Platz E, Lewis EF, Uno H, Peck J, Pivetta E, Merz AA et al. Detection and prognostic value of pulmonary congestion by lung ultrasound in ambulatory heart failure patients. European Heart Journal. 2016;37(15):1244–51. DOI: 10.1093/eurheartj/ehv745

58. Ricci F, Aquilani R, Radico F, Bianco F, Dipace GG, Miniero E et al. Role and importance of ultrasound lung comets in acute cardiac care. European Heart Journal: Acute Cardiovascular Care. 2015;4(2):103– 12. DOI: 10.1177/2048872614553166

59. Shyamsundar M, Attwood B, Keating L, Walden AP. Clinical review: The role of ultrasound in estimating extra-vascular lung water. Critical Care. 2013;17(5):237. DOI: 10.1186/cc12710

60. Anile A, Russo J, Castiglione G, Volpicelli G. A simplified lung ultrasound approach to detect increased extravascular lung water in critically ill patients. Critical Ultrasound Journal. 2017;9(1):13. DOI: 10.1186/s13089-017-0068-x

61. Bedetti G, Gargani L, Sicari R, Gianfaldoni ML, Molinaro S, Picano E. Comparison of Prognostic Value of Echocardiacgraphic Risk Score With the Thrombolysis In Myocardial Infarction (TIMI) and Global Registry In Acute Coronary Events (GRACE) Risk Scores in Acute Coronary Syndrome. The American Journal of Cardiology. 2010;106(12):1709–16. DOI: 10.1016/j.amjcard.2010.08.024

62. Miglioranza MH, Gargani L, Sant’Anna RT, Rover MM, Martins VM, Mantovani A et al. Lung Ultrasound for the Evaluation of Pulmonary Congestion in Outpatients: a comparison with clinical assessment, natriuretic peptides, and echocardiography. JACC: Cardiovascular Imaging. 2013;6(11):1141–51. DOI: 10.1016/j.jcmg.2013.08.004

63. Brogi E, Gargani L, Bignami E, Barbariol F, Marra A, Forfori F et al. Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment. Critical Care. 2017;21(1):325. DOI: 10.1186/s13054-017-1897-5

64. Lichtenstein D. Novel approaches to ultrasonography of the lung and pleural space: where are we now? Breathe. 2017;13(2):100–11. DOI: 10.1183/20734735.004717

65. Morales-Rull JL, Bielsa S, Conde-Martel A, Aramburu-Bodas O, Llàcer P, Quesada MA et al. Pleural effusions in acute decompensated heart failure: Prevalence and prognostic implications. European Journal of Internal Medicine. 2018;52:49–53. DOI: 10.1016/j.ejim.2018.02.004

66. Atkinson P, Milne J, Loubani O, Verheul G. The V-line: a sonographic aid for the confirmation of pleural fluid. Critical Ultrasound Journal. 2012;4(1):19. PMID: 22920298

67. Goffi A, Kruisselbrink R, Volpicelli G. The sound of air: point-of-care lung ultrasound in perioperative medicine. Canadian Journal of Anaesthesia = Journal Canadien D’anesthesie. 2018;65(4):399–416. DOI: 10.1007/s12630-018-1062-x

68. Tavazzi G, Neskovic AN, Hussain A, Volpicelli G, Via G. A plea for an early ultrasound-clinical integrated approach in patients with acute heart failure. A proactive comment on the ESC Guidelines on Heart Failure 2016. International Journal of Cardiology. 2017;245:207–10. DOI: 10.1016/j.ijcard.2017.07.013

69. Stolz L, O’Brien K, Miller M, Winters-Brown N, Blaivas M, Adhikari S. A Review of Lawsuits Related to Point-of-Care Emergency Ultrasound Applications. Western Journal of Emergency Medicine. 2015;16(1):1–4. DOI: 10.5811/westjem.2014.11.23592

70. Nazerian P, Volpicelli G, Gigli C, Lamorte A, Grifoni S, Vanni S. Diagnostic accuracy of focused cardiac and venous ultrasound examinations in patients with shock and suspected pulmonary embolism. Internal and Emergency Medicine. 2018;13(4):567–74. DOI: 10.1007/s11739-017-1681-1

71. Volpicelli G, Vanni S, Becattini C, Sferrazza Papa GF, Gigli C, Grifoni S et al. Prediction Rule for Diagnosis of Pulmonary Embolism Enhanced by Lung and Venous Ultrasound: Making Confusion or Increasing Efficiency? Academic Emergency Medicine. 2017;24(4):498–9. DOI: 10.1111/acem.13153

72. Nazerian P, Vanni S, Volpicelli G, Gigli C, Zanobetti M, Bartolucci M et al. Accuracy of Point-of-Care Multiorgan Ultrasonography for the Diagnosis of Pulmonary Embolism. Chest. 2014;145(5):950–7. DOI: 10.1378/chest.13-1087

73. Malbrain MLNG, De Tavernier B, Haverals S, Slama M, VieillardBaron A, Wong A et al. Executive summary on the use of ultrasound in the critically ill: consensus report from the 3rd Course on Acute Care Ultrasound (CACU). Anaesthesiology Intensive Therapy. 2017;49(5):393–411. DOI: 10.5603/AIT.a2017.0072

74. Havelock T, Teoh R, Laws D, Gleeson F, BTS Pleural Disease Guideline Group. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(Suppl 2):ii61-76. DOI: 10.1136/thx.2010.137026

75. Dancel R, Schnobrich D, Puri N, Franco-Sadud R, Cho J, Grikis L et al. Recommendations on the Use of Ultrasound Guidance for Adult Thoracentesis: A Position Statement of the Society of Hospital Medicine. Journal of Hospital Medicine. 2018;13(2):126–35. DOI: 10.12788/jhm.2940

76. Sicari R, Galderisi M, Voigt J-U, Habib G, Zamorano JL, Lancellotti P et al. The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography. European Journal of Echocardiography. 2011;12(2):85–7. DOI: 10.1093/ejechocard/jeq184

77. Neskovic AN, Hagendorff A, Lancellotti P, Guarracino F, Varga A, Cosyns B et al. Emergency echocardiography: the European Association of Cardiovascular Imaging recommendations. European Heart Journal Cardiovascular Imaging. 2013;14(1):1–11. DOI: 10.1093/ehjci/jes193

78. Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S et al. Recommendations on pre-hospital and early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine – short version. European Heart Journal. 2015;36(30):1958–66. DOI: 10.1093/eurheartj/ehv066

79. Price S, Platz E, Cullen L, Tavazzi G, Christ M, Cowie MR et al. Echocardiography and lung ultrasonography for the assessment and management of acute heart failure. Nature Reviews Cardiology. 2017;14(7):427–40. DOI: 10.1038/nrcardio.2017.56

80. Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R et al. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. European Heart Journal – Cardiovascular Imaging. 2016;17(11):1191–229. DOI: 10.1093/ehjci/jew190