Thoraxsonography--Part I: Chest wall and pleura.

The fact that ultrasound (US) waves are reflected completely by the bony thorax and are erased from the aerated lung to a large extent led to the mistaken notion that sonography is not a very useful diagnostic tool for use in this region. On the other hand, since the beginning of US imaging, reports have been published regularly on pleuropulmonary sonographic diagnostic and therapeutic procedures. Rib fractures could be detected about twice as often by US than x-ray. With regard to determining the nodal status in neoplastic disease of the axilla and supraclavicular fossa, US is superior to palpation. In imaging pleural effusions, US is more accurate than chest film and is useful in determining the nature of the pleural effusion. Sonographic evidence of pleural nodules is a specific finding in patients with a malignant effusion. Chest sonography is a useful diagnostic tool for critically ill patients with chest diseases. Performed at the bedside, this technique can be particularly helpful when computed tomography is not available or when critically ill patients cannot be moved.