Induction of pulmonary hemorrhage in rats during diagnostic ultrasound.

The induction of pulmonary hemorrhage by pulsed ultrasound was discovered over 20 years ago. This phenomenon may pose a risk of patient lung injury, particularly for point of care pulmonary ultrasound. A diagnostic ultrasound machine (HDI 5000; Philips Healthcare, Andover MA USA) with 7.6 MHz (CL15-7) linear array was used to image the right lung of anesthetized rats in a warmed water bath. The image showed rapid initiation and progression of comet tail artifacts across the lung image for an on-screen mechanical index (MI) of 0.9, which corresponded to a pulmonary hemorrhage in the lung. Groups of rats were scanned at a range of MI settings and a threshold was located at an MI of about 0.44. This finding indicated a greater sensitivity to pulmonary ultrasound than was expected, based on previous results. Further research is needed to understand this phenomenon and to develop safety guidelines for sonographers.