Alessandro Zanforlin1, Vanina Livi2, Carlo Santoriello3, Paolo Ceruti4, Marco Trigiani5, Manlio Valerio6, Cristiano Perani7, Paolo Carlucci8, Antonio Palmiotti9, Giampietro Marchetti10. 1. SOC Medicina, Ospedale San Luca, Trecenta, Italy. Electronic address: alessandro.zanforlin@gmail.com. 2. UO Pneumologia Interventistica, Policlinico Sant'Orsola-Malpighi, Bologna, Italy. 3. UOC Polo Pneumologico, Presidio Ospedaliero Mauro Scarlato di Scafati (SA), ASL Salerno, Salerno, Italy. 4. UO Pneumologia e Fisiopatologia Respiratoria, Spedali Civili di Brescia, Brescia, Italy. 5. SOD Pneumologia Interventistica AOUC, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. 6. Medicina e Chirurgia d'Accettazione e d'Urgenza, Ente Ospedaliero Ospedali Galliera, Genoa, Italy. 7. Pronto Soccorso, Dipartimento di Anestesia, Rianimazione, Emergenza e Urgenza, ASST degli Spedali Civili di Brescia, Brescia, Italy. 8. UOC Pneumologia, ASST Santi Paolo e Carlo, Milan, Italy. 9. Dipartimento di Medicina Specialistica, Malattie dell'Apparato Respiratorio, Università di Foggia, Foggia, Italy. 10. Divisione Pneumologia, Spedali Civili di Brescia, Brescia, Italy.
Abstract
BACKGROUND: Lung ultrasound examination is becoming an even more important part of pulmonologists' clinical routine. As indicated in the literature, the coordinates of any findings on lung parenchyma are based on surface landmarks or conventional quadrants. In our experience we have noticed that lung fissures are clearly detectable as interruptions of the pleural line, but this has never been investigated previously. The aim of this study was to evaluate whether lung fissures are detectable under normal conditions in routine clinical practice. METHODS: Ten operators were enrolled from Pleural-Hub, a scientific discussion group. After compiling a prestudy survey to investigate whether they had observed fissures previously, they were asked to note if the following fissures were detectable: posterior right (PR) and left (PL), lateral right (LR) and left (LL), anterior right (AR), and anterolateral left (AL). Enrollment was competitive, aiming to reach 100 case subjects. RESULTS: We found that general fissure detection was 61.3%, in particular: PR, 59%; LR, 75%; AR, 69%; PL, 45%; LL, 64%; AL, 56%. Single operators yielded different detection rates ranging from 90% to 25%, showing strong operator dependency. Before being made aware of general results operators indicated operator's skill and rib shadow artifacts as the principal factors affecting fissure detection. CONCLUSIONS: Lung fissures may be detected with ultrasound once adequate training is provided. This may allow the clinician a more precise anatomical delineation of pathology identified by lung ultrasound.
BACKGROUND: Lung ultrasound examination is becoming an even more important part of pulmonologists' clinical routine. As indicated in the literature, the coordinates of any findings on lung parenchyma are based on surface landmarks or conventional quadrants. In our experience we have noticed that lung fissures are clearly detectable as interruptions of the pleural line, but this has never been investigated previously. The aim of this study was to evaluate whether lung fissures are detectable under normal conditions in routine clinical practice. METHODS: Ten operators were enrolled from Pleural-Hub, a scientific discussion group. After compiling a prestudy survey to investigate whether they had observed fissures previously, they were asked to note if the following fissures were detectable: posterior right (PR) and left (PL), lateral right (LR) and left (LL), anterior right (AR), and anterolateral left (AL). Enrollment was competitive, aiming to reach 100 case subjects. RESULTS: We found that general fissure detection was 61.3%, in particular: PR, 59%; LR, 75%; AR, 69%; PL, 45%; LL, 64%; AL, 56%. Single operators yielded different detection rates ranging from 90% to 25%, showing strong operator dependency. Before being made aware of general results operators indicated operator's skill and rib shadow artifacts as the principal factors affecting fissure detection. CONCLUSIONS: Lung fissures may be detected with ultrasound once adequate training is provided. This may allow the clinician a more precise anatomical delineation of pathology identified by lung ultrasound.
Authors: Marina Attanasi; Simone Pasini; Antonio Caronni; Giulia Michela Pellegrino; Paola Faverio; Sabrina Di Pillo; Matteo Maria Cimino; Giuseppe Cipolla; Francesco Chiarelli; Stefano Centanni; Giuseppe Francesco Sferrazza Papa Journal: Respiration Date: 2020-08-05 Impact factor: 3.580