Ultrasound of extravascular lung water: A new standard for pulmonary congestion

Eugenio Picano, Patricia Pellikka

Research output: Contribution to journalReview article

117 Citations (Scopus)

Abstract

Extravascular lung water (EVLW) is a key variable in heart failure management and prognosis, but its objective assessment remains elusive. Lung imaging has been traditionally considered off-limits for ultrasound techniques due to the acoustic barrier of high-impedance air wall. In pulmonary congestion however, the presence of both air and water creates a peculiar echo fingerprint. Lung ultrasound shows B-lines, comet-like signals arising from a hyper-echoic pleural line with a to-and-fro movement synchronized with respiration. Increasing EVLW accumulation changes the normal, no-echo signal (black lung, no EVLW) into a black-and-white pattern (interstitial sub-pleural oedema with multiple B-lines) or a white lung pattern (alveolar pulmonary oedema) with coalescing B-lines. The number and spatial extent of B-lines on the antero-lateral chest allows a semi-quantitative estimation of EVLW (from absent, ≤5, to severe pulmonary oedema, >30 B-lines). Wet B-lines are made by water and decreased by diuretics, which cannot modify dry B-lines made by connective tissue. B-lines can be evaluated anywhere (including extreme environmental conditions with pocket size instruments to detect high-altitude pulmonary oedema), anytime (during dialysis to titrate intervention), by anyone (even a novice sonographer after 1 h training), and on anybody (since the chest acoustic window usually remains patent when echocardiography is not feasible). Cardiologists can achieve much diagnostic gain with little investment of technology, training, and time. B-lines represent 'the shape of lung water'. They allow non-invasive detection, in real time, of even sub-clinical forms of pulmonary oedema with a low cost, radiation-free approach.

Original languageEnglish (US)
Pages (from-to)2097-2104
Number of pages8
JournalEuropean Heart Journal
Volume37
Issue number27
DOIs
StatePublished - Jul 14 2016

Fingerprint

Extravascular Lung Water
Pulmonary Edema
Lung
Acoustics
Water
Thorax
Air
Anthracosis
Dermatoglyphics
Electric Impedance
Diuretics
Connective Tissue
Echocardiography
Dialysis
Edema
Respiration
Heart Failure
Radiation
Technology
Costs and Cost Analysis

Keywords

  • Lung
  • Oedema
  • Ultrasound
  • Water

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Ultrasound of extravascular lung water : A new standard for pulmonary congestion. / Picano, Eugenio; Pellikka, Patricia.

In: European Heart Journal, Vol. 37, No. 27, 14.07.2016, p. 2097-2104.

Research output: Contribution to journalReview article

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