Semin Respir Crit Care Med 2014; 35(06): 693-705
DOI: 10.1055/s-0034-1395794
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ultrasound-Guided Pleural Access

Samira Shojaee
1   Division of Interventional Pulmonology, Department of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, Virginia
,
A. Christine Argento
2   Division of Interventional Pulmonology, Department of Pulmonary and Critical Care Medicine, Emory University, Atlanta, Georgia
› Author Affiliations
Further Information

Publication History

Publication Date:
02 December 2014 (online)

Abstract

Ultrasonography of the thorax has become a more recognized tool in pulmonary medicine, thanks to continuing clinical research that has proven its many valuable roles in the day-to-day management of pulmonary and pleural diseases. Ultrasound examination is a cost-effective imaging modality that permits the pulmonologist to obtain information about the pathologies in the thorax without the risk of exposure to ionizing radiation, providing the examiner with real-time and immediate results. Its ease of use and training along with its portability to the patient's bedside and accurate examination of the pleural space has allowed for safer pleural procedures such as thoracentesis, chest tube placement, tunneled pleural catheter placement, and medical thoracoscopy. In this review, we summarize the technique of chest ultrasonography, compare ultrasound to other frequently used thoracic imaging modalities, and focus on its use in obtaining pleural access while performing invasive pleural procedures.

 
  • References

  • 1 Newman PG, Rozycki GS. The history of ultrasound. Surg Clin North Am 1998; 78 (2) 179-195
  • 2 Goldberg BB, Gramiak R, Freimanis AK. Early history of diagnostic ultrasound: the role of American radiologists. AJR Am J Roentgenol 1993; 160 (1) 189-194
  • 3 Pell RL. Ultrasound for routine clinical investigation. Ultrasonics 1964; 2 (2) 87-89
  • 4 Joyner Jr CR, Herman RJ, Reid JM. Reflected ultrasound in the detection and localization of pleural effusion. JAMA 1967; 200 (5) 399-402
  • 5 Rantanen NW. Diseases of the thorax. Vet Clin North Am Equine Pract 1986; 2 (1) 49-66
  • 6 Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med 2011; 364 (8) 749-757
  • 7 Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007; 357 (22) 2277-2284
  • 8 Wells PN. Ultrasound imaging. Phys Med Biol 2006; 51 (13) R83-R98
  • 9 Berg B. Diagnostic Ultrasound: A Logical Approach. Philadelphia, PA: Lippincott-Raven Publishers; 1998: 1-19
  • 10 Bakhru RN, Schweickert WD. Intensive care ultrasound: I. Physics, equipment, and image quality. Ann Am Thorac Soc 2013; 10 (5) 540-548
  • 11 Kalokairinou-Motogna M, Maratou K, Paianid I , et al. Application of color Doppler ultrasound in the study of small pleural effusion. Med Ultrason 2010; 12 (1) 12-16
  • 12 Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 1997; 156 (5) 1640-1646
  • 13 Soldati G, Copetti R, Sher S. Sonographic interstitial syndrome: the sound of lung water. J Ultrasound Med 2009; 28 (2) 163-174
  • 14 Volpicelli G, Mussa A, Garofalo G , et al. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med 2006; 24 (6) 689-696
  • 15 Cardinale L, Priola AM, Moretti F, Volpicelli G. Effectiveness of chest radiography, lung ultrasound and thoracic computed tomography in the diagnosis of congestive heart failure. World J Radiol 2014; 6 (6) 230-237
  • 16 Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008; 134 (1) 117-125
  • 17 Volpicelli G, Caramello V, Cardinale L, Mussa A, Bar F, Frascisco MF. Detection of sonographic B-lines in patients with normal lung or radiographic alveolar consolidation. Med Sci Monit 2008; 14 (3) CR122-CR128
  • 18 Hayek V. The Parietal Pleura (Pleura Parietalis) and the Visceral Pleura (Pleura Pulmonalis) in the Human Lung. New York, NY: Hafner Publishing Co; 1960
  • 19 English JC, Leslie KO. Pathology of the pleura. Clin Chest Med 2006; 27 (2) 157-180
  • 20 Davies J. Development of the Respiratory System in Human Developmental Anatomy. New York, NY: Ronald Press; 1963: 135-143
  • 21 Rahman N, Wang N. Anatomy of the pleura. In: Light RW, Lee G, Gary Lee YC, , eds. Textbook of Pleural Diseases. 2nd ed. London: Hodder & Stoughton Ltd; 2008: 13-25
  • 22 Davila RM, Crouch EC. Anatomic organisation and function of the human pleura. Semin Respir Crit Care Med 1979; 82: 783-797
  • 23 Bernaudin JF, Fleury JY. Anatomy of the blood and lymphatic circulation of the pleural serosa. In: Chretien J, Bignon J, Hirsch A, , eds. The Pleural in Health and Disease. New York: Marcel Dekker; 1985: 101-124
  • 24 Milne ENC, Pistolesi M. Reading the Chest Radiograph: A Physiologic Approach. St Louis, MO: Mosby; 1993
  • 25 Wang NS. The regional difference of pleural mesothelial cells in rabbits. Am Rev Respir Dis 1974; 110 (5) 623-633
  • 26 Mariassy AT, Wheeldon EB. The pleura: a combined light microscopic, scanning, and transmission electron microscopic study in the sheep. I. Normal pleura. Exp Lung Res 1983; 4 (4) 293-314
  • 27 Gaudio E, Rendina EA, Pannarale L, Ricci C, Marinozzi G. Surface morphology of the human pleura. A scanning electron microscopic study. Chest 1988; 93 (1) 149-153
  • 28 Albertine KH, Wiener-Kronish JP, Roos PJ, Staub NC. Structure, blood supply, and lymphatic vessels of the sheep's visceral pleura. Am J Anat 1982; 165 (3) 277-294
  • 29 Moskowitz H, Platt RT, Schachar R, Mellins H. Roentgen visualization of minute pleural effusion. An experimental study to determine the minimum amount of pleural fluid visible on a radiograph. Radiology 1973; 109 (1) 33-35
  • 30 Light RW. Pleural diseases. In: Light RW, , ed. Pleural Diseases. 6th ed. Philadelphia, PA: Lippincott, Williams &Wilkins; 2012: 70-72
  • 31 Marks WM, Filly RA, Callen PW. Real-time evaluation of pleural lesions: new observations regarding the probability of obtaining free fluid. Radiology 1982; 142 (1) 163-164
  • 32 Henschke CI, Yankelevitz DF, Davis SD. Pleural diseases: multimodality imaging and clinical management. Curr Probl Diagn Radiol 1991; 20 (5) 155-181
  • 33 Yilmaz U, Polat G, Sahin N, Soy O, Gülay U. CT in differential diagnosis of benign and malignant pleural disease. Monaldi Arch Chest Dis 2005; 63 (1) 17-22
  • 34 Yu CJ, Yang PC, Wu HD, Chang DB, Kuo SH, Luh KT. Ultrasound study in unilateral hemithorax opacification. Image comparison with computed tomography. Am Rev Respir Dis 1993; 147 (2) 430-434
  • 35 McLoud TC, Flower CD. Imaging the pleura: sonography, CT, and MR imaging. AJR Am J Roentgenol 1991; 156 (6) 1145-1153
  • 36 Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG. Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest 2008; 133 (1) 204-211
  • 37 Rowan KR, Kirkpatrick AW, Liu D, Forkheim KE, Mayo JR, Nicolaou S. Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT—initial experience. Radiology 2002; 225 (1) 210-214
  • 38 Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest 2012; 141 (3) 703-708
  • 39 Lichtenstein DA, Mezière G, Lascols N , et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005; 33 (6) 1231-1238
  • 40 Kocijancic I, Vidmar K, Ivanovi-Herceg Z. Chest sonography versus lateral decubitus radiography in the diagnosis of small pleural effusions. J Clin Ultrasound 2003; 31 (2) 69-74
  • 41 Kohan JM, Poe RH, Israel RH , et al. Value of chest ultrasonography versus decubitus roentgenography for thoracentesis. Am Rev Respir Dis 1986; 133 (6) 1124-1126
  • 42 Tu CY, Hsu WH, Hsia TC , et al. Pleural effusions in febrile medical ICU patients: chest ultrasound study. Chest 2004; 126 (4) 1274-1280
  • 43 Sajadieh H, Afzali F, Sajadieh V, Sajadieh A. Ultrasound as an alternative to aspiration for determining the nature of pleural effusion, especially in older people. Ann N Y Acad Sci 2004; 1019: 585-592
  • 44 Marcun R, Sustic A. Sonographic evaluation of unexplained pleural exudate: a prospective case series. Wien Klin Wochenschr 2009; 121 (9-10) 334-338
  • 45 Diacon AH, Brutsche MH, Solèr M. Accuracy of pleural puncture sites: a prospective comparison of clinical examination with ultrasound. Chest 2003; 123 (2) 436-441
  • 46 Raptopoulos V, Davis LM, Lee G, Umali C, Lew R, Irwin RS. Factors affecting the development of pneumothorax associated with thoracentesis. AJR Am J Roentgenol 1991; 156 (5) 917-920
  • 47 Lichtenstein D, Mezière G. A lung ultrasound sign allowing bedside distinction between pulmonary edema and COPD: the comet-tail artifact. Intensive Care Med 1998; 24 (12) 1331-1334
  • 48 Lichtenstein D, Mezière G, Biderman P, Gepner A. The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med 2000; 26 (10) 1434-1440
  • 49 Lichtenstein D, Mezière G, Biderman P, Gepner A. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 1999; 25 (4) 383-388
  • 50 Lichtenstein DA, Lascols N, Prin S, Mezière G. The “lung pulse”: an early ultrasound sign of complete atelectasis. Intensive Care Med 2003; 29 (12) 2187-2192
  • 51 Lyn-Kew KE, Koenig SJ. Bedside ultrasound for the interventional pulmonologist. Clin Chest Med 2013; 34 (3) 473-485
  • 52 Chen CH, Chen W, Chen HJ , et al. Transthoracic ultrasonography in predicting the outcome of small-bore catheter drainage in empyemas or complicated parapneumonic effusions. Ultrasound Med Biol 2009; 35 (9) 1468-1474
  • 53 Medford AR, Agrawal S, Bennett JA, Free CM, Entwisle JJ. Thoracic ultrasound prior to medical thoracoscopy improves pleural access and predicts fibrous septation. Respirology 2010; 15 (5) 804-808
  • 54 Mathis G. Thoraxsonographie—Teil 1: Brustkorb und Pleura [Thoraxsonography—Part 1: Chest wall and pleura]. Praxis (Bern 1994) 2004; 93 (15) 615-621
  • 55 Mayo PH, Beaulieu Y, Doelken P , et al. American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. Chest 2009; 135 (4) 1050-1060
  • 56 Graham EA. The treatment of pulmonary suppuration. Ann Surg 1927; 86 (2) 174-181
  • 57 Peters RM. Empyema thoracis: historical perspective. Ann Thorac Surg 1989; 48 (2) 306-308
  • 58 Meyer JA. Gotthard Bülau and closed water-seal drainage for empyema, 1875-1891. Ann Thorac Surg 1989; 48 (4) 597-599
  • 59 Churchill ED. Wound surgery encounters a dilemma. J Thorac Surg 1958; 35 (3) 279-290
  • 60 Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med 2010; 170 (4) 332-339
  • 61 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. 02) ii61-ii76
  • 62 ACGME program requirements for fellowship education in 2 pulmonary disease and critical care medicine (internal medicine). Available at: www.acgme.org/acwebsite/rrc_140/140_prIndex.asp
  • 63 Duncan DR, Morgenthaler TI, Ryu JH, Daniels CE. Reducing iatrogenic risk in thoracentesis: establishing best practice via experiential training in a zero-risk environment. Chest 2009; 135 (5) 1315-1320
  • 64 Koenig SJ, Narasimhan M, Mayo PH. Thoracic ultrasonography for the pulmonary specialist. Chest 2011; 140 (5) 1332-1341
  • 65 Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH. Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. AJR Am J Roentgenol 1992; 159 (1) 29-33
  • 66 Sachdeva A, Shepherd RW, Lee HJ. Thoracentesis and thoracic ultrasound: state of the art in 2013. Clin Chest Med 2013; 34 (1) 1-9
  • 67 Roch A, Bojan M, Michelet P , et al. Usefulness of ultrasonography in predicting pleural effusions > 500 mL in patients receiving mechanical ventilation. Chest 2005; 127 (1) 224-232
  • 68 Balik M, Plasil P, Waldauf P , et al. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med 2006; 32 (2) 318-321
  • 69 Lomas DJ, Padley SG, Flower CD. The sonographic appearances of pleural fluid. Br J Radiol 1993; 66 (787) 619-624
  • 70 Jones PW, Moyers JP, Rogers JT, Rodriguez RM, Lee YC, Light RW. Ultrasound-guided thoracentesis: is it a safer method?. Chest 2003; 123 (2) 418-423
  • 71 Barnes TW, Morgenthaler TI, Olson EJ, Hesley GK, Decker PA, Ryu JH. Sonographically guided thoracentesis and rate of pneumothorax. J Clin Ultrasound 2005; 33 (9) 442-446
  • 72 Wrightson JM, Fysh E, Maskell NA, Lee YC. Risk reduction in pleural procedures: sonography, simulation and supervision. Curr Opin Pulm Med 2010; 16 (4) 340-350
  • 73 Patel PA, Ernst FR, Gunnarsson CL. Ultrasonography guidance reduces complications and costs associated with thoracentesis procedures. J Clin Ultrasound 2012; 40 (3) 135-141s
  • 74 Ponrartana S, Laberge JM, Kerlan RK, Wilson MW, Gordon RL. Management of patients with “ex vacuo” pneumothorax after thoracentesis. Acad Radiol 2005; 12 (8) 980-986
  • 75 Feller-Kopman D, Walkey A, Berkowitz D, Ernst A. The relationship of pleural pressure to symptom development during therapeutic thoracentesis. Chest 2006; 129 (6) 1556-1560
  • 76 Feller-Kopman D, Berkowitz D, Boiselle P, Ernst A. Large-volume thoracentesis and the risk of reexpansion pulmonary edema. Ann Thorac Surg 2007; 84 (5) 1656-1661
  • 77 Feller-Kopman D. Therapeutic thoracentesis: the role of ultrasound and pleural manometry. Curr Opin Pulm Med 2007; 13 (4) 312-318
  • 78 Capizzi SA, Prakash UB. Chest roentgenography after outpatient thoracentesis. Mayo Clin Proc 1998; 73 (10) 948-950
  • 79 Doyle JJ, Hnatiuk OW, Torrington KG, Slade AR, Howard RS. Necessity of routine chest roentgenography after thoracentesis. Ann Intern Med 1996; 124 (9) 816-820
  • 80 Alemán C, Alegre J, Armadans L , et al. The value of chest roentgenography in the diagnosis of pneumothorax after thoracentesis. Am J Med 1999; 107 (4) 340-343
  • 81 Cervini P, Hesley GK, Thompson RL, Sampathkumar P, Knudsen JM. Incidence of infectious complications after an ultrasound-guided intervention. AJR Am J Roentgenol 2010; 195 (4) 846-850
  • 82 Carney M, Ravin CE. Intercostal artery laceration during thoracocentesis: increased risk in elderly patients. Chest 1979; 75 (4) 520-522
  • 83 McVay PA, Toy PT. Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities. Transfusion 1991; 31 (2) 164-171
  • 84 Puchalski JT, Argento AC, Murphy TE, Araujo KL, Pisani MA. The safety of thoracentesis in patients with uncorrected bleeding risk. Ann Am Thorac Soc 2013; 10 (4) 336-341
  • 85 Mahmood K, Shofer SL, Moser BK, Argento AC, Smathers EC, Wahidi MM. Hemorrhagic complications of thoracentesis and small-bore chest tube placement in patients taking clopidogrel. Ann Am Thorac Soc 2014; 11 (1) 73-79
  • 86 Tarver RD, Broderick LS, Conces Jr DJ. Reexpansion pulmonary edema. J Thorac Imaging 1996; 11 (3) 198-209
  • 87 Pavlin J, Cheney Jr FW. Unilateral pulmonary edema in rabbits after reexpansion of collapsed lung. J Appl Physiol 1979; 46 (1) 31-35
  • 88 Christopoulou-Aletra H, Papavramidou N. “Empyemas” of the thoracic cavity in the Hippocratic Corpus. Ann Thorac Surg 2008; 85 (3) 1132-1134
  • 89 Hewett FC. Thoracentesis: The plan of continuous aspiration. BMJ 1876; 1 (793) 317
  • 90 Tassi GF, Marchetti GP. Pleural disease: historic perspective. In: Light RW, Lee G, Gary Lee YC, , eds. Textbook of Pleural Diseases. 2nd ed. London: Hodder & Stoughton Ltd; 2008: 344-356
  • 91 Gayer G, Rozenman J, Hoffmann C , et al. CT diagnosis of malpositioned chest tubes. Br J Radiol 2000; 73 (871) 786-790
  • 92 Millikan JS, Moore EE, Steiner E, Aragon GE, Van Way III CW. Complications of tube thoracostomy for acute trauma. Am J Surg 1980; 140 (6) 738-741
  • 93 Tang AT, Velissaris TJ, Weeden DF. An evidence-based approach to drainage of the pleural cavity: evaluation of best practice. J Eval Clin Pract 2002; 8 (3) 333-340
  • 94 Mahmood K, Wahidi MM. Straightening out chest tubes: what size, what type, and when. Clin Chest Med 2013; 34 (1) 63-71
  • 95 Moulton JS. Image-guided management of complicated pleural fluid collections. Radiol Clin North Am 2000; 38 (2) 345-374
  • 96 vanSonnenberg E, Nakamoto SK, Mueller PR , et al. CT- and ultrasound-guided catheter drainage of empyemas after chest-tube failure. Radiology 1984; 151 (2) 349-353
  • 97 Silverman SG, Mueller PR, Saini S , et al. Thoracic empyema: management with image-guided catheter drainage. Radiology 1988; 169 (1) 5-9
  • 98 Mayo PH, Goltz HR, Tafreshi M, Doelken P. Safety of ultrasound-guided thoracentesis in patients receiving mechanical ventilation. Chest 2004; 125 (3) 1059-1062
  • 99 Gulati M, Venkataramu NK, Gupta S , et al. Ultrasound guided fine needle aspiration biopsy in mediastinal tuberculosis. Int J Tuberc Lung Dis 2000; 4 (12) 1164-1168
  • 100 Kwiatt M, Tarbox A, Seamon MJ , et al. Thoracostomy tubes: a comprehensive review of complications and related topics. Int J Crit Illn Inj Sci 2014; 4 (2) 143-155
  • 101 Baumann MH, Patel PB, Roney CW, Petrini MF. Comparison of function of commercially available pleural drainage units and catheters. Chest 2003; 123 (6) 1878-1886
  • 102 Cafarotti S, Dall'Armi V, Cusumano G , et al. Small-bore wire-guided chest drains: safety, tolerability, and effectiveness in pneumothorax, malignant effusions, and pleural empyema. J Thorac Cardiovasc Surg 2011; 141 (3) 683-687
  • 103 Light RW. Pleural controversy: optimal chest tube size for drainage. Respirology 2011; 16 (2) 244-248