الفهرس 
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Abstract
Ultrasonic examination of the chest is a rapidly developing application and may be used to evaluate a wide range of parenchymal diseases. The technique is particularly suited to bedsideuse in the intensive care unit, Furthermore, US isincreasingly used to guide interventional procedures of the chest, such as transthoracic biopsy.
The purpose of this study was to demonstrate the diagnostic role of thoracic ultrasonography in pulmonary (parenchymal)diseases and its safety.
This study included300 patientswith their agesranged between 35 to 67
years old (mean age 51+16 years) 144 (48%) were males and 156(52%) were females. The study setting included the respiratory medicine ward and respiratory ICU. Patients admitted forrespiratory symptoms (dyspnea, cough with fever, chest pain, chest wheeze, expectoration, hemoptysisand cyanosis)and/orchest X- ray lesions,were enrolled and evaluated by LUS inaddition to the standard clinical, laboratory and imagingtechnique workup (CXR and CT scan).
This study clearly delineates that TUS presents a reliable technique for diagnosing PEs with a high sensitivity but considerably limited specificity. So a negative TUS examination cannot rule out PE with certainty, but positive TUS findings may prove a valuable tool especially with adding color Doppler to gray scale examination which increases the confidence of diagnosis and rules out alternative differential diagnoses to
pulmonary embolism.
This study highlights the high accuracy of TUS in diagnosis of pneumonia (88%), and its additional role to explore complicated cases either with parapneumonic effusion or with lung abcess formation.
US is superior to CT in the detection of complex septated pleural effusion.
TUS was a valuable and sensitive tool to detect the cases of lung abcess and differentiated them from cases of pyopneumothoraxby preservation of gliding signs on thelesion in all cases during the US technique.
The current study showed that there was high statistically significant difference bet CT and U/S in the detection rate of different types of lesion in lung tumour cases, U/S was superior to CT in detection of chest invasion with rib erosion, supraclavicular LNs, pleural effusion, diaphragmatic mobility and detection of necrosis within the mass.
There was statistically significant difference between malignant and non-malignant cases as regard echogenecity of the lesions in U/S.
This study demonstrates that US-guided transthoracic TCB was accurate and safe, as it successed in 96% in reach to conclusive diagnosis from the first trial with low rate of complications which all were treated conservatively.
As regard the most “revolutionary” sign of LUS ”B- lines” which used for the evaluation of interstitial syndrome, there was statistically significant difference between ARDS and pulmonary edema groups in L/U findings as regard pleural line abnormalities, presence or absence of gliding signs, presence of consolidation and pleural effusion.
We found positive correlation between B-line distance in LUS and reticular pattern in HRCT, and disease duration. There was negative correlation between B-line distance in LUS and GGO in HRCT and FVC by spirometry.
Conclusion
Thoracic ultrasonography is a promising tool in the evaluation of lung pathology as it is fast, inexpensive, non invasive, user friendly, easily reproducible, portable, widely available, and involves no ionizing radiation. It may partially replaced CT in certain situations.The expressed results confirmed the synergistic role of TUS and made the concept of ‘ultrasound stethoscope’ workable.
Thoracic ultrasound adds significant value in diagnosing patients with suspected pulmonary embolism, pneumonia, lung mass, pulmonary edema(cardiogenic or noncardiogenic) and ILD. Thoracic Ultrasound is particularly valuable in the differential diagnosis and detection of complications among pulmonary diseases.
It allows for an immediate and mobile assessment that can potentially augment the physical examination of the chest.It is an interesting medical method that is complementary to bedside CXR and reduces the need to use a CT scan.Therefore, it should be implemented into emergency diagnostic procedures of patients presenting with chest symptoms and in critically ill patients.
Diagnostic interventions in patients with pathologic pulmonary findings can tolerably be performed with no sedation, with minimal monitoringand under real-time ultrasound guidance, by providing dynamic images during taking the biopsy enabling the operator to be sure of exactly what the needle is targeting or has passed through and avoiding the vascular areas by using colour Doppler U/S before the procedure.
Limitations
We had limited number of patients in each distinctive group ofpulmonary disease, which made us interpret group results with more caution.
Pa¬tient and operator factors play a large role in the performance of TUS. Image quality at US is heavily dependent on sonographer skill (operator dependent) and Patient factors such as obesity, the presence of edema or subcutaneous emphysema and patient cooperation. Suboptimal patient position can reduce image quality and make interpretation difficult in ICU.
Centrally localized lesions and lesions hidden behind a bony structuregenerally escapesonographic detection, which constitutes a major limitation of TUS.
Several lung signs at US are artifacts, these artifacts are affected by machine factors such as focal zone, frequency, and gain settings
Recommendations
Further studies with multiple physicians and larger sample sizes are necessary to better outline these shortcomings.
For many respiratory physicians, chest ultrasound should be an integral part of clinical practice, it should be as important as stethoscope for them. It is up to pulmonologists and radiologists to move forward together in the understanding of sonography and to integrate it progressively into routine clinical practice
Appropriate training on chest ultrasonography is needed to ensure proper application and interpretation of this technique. Good understanding of sonographic properties of the thorax are essential to building expertise in bedside lung ultrasound.