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RESPONSE OF AUTHOR TO COMMENTS
Year : 2016  |  Volume : 60  |  Issue : 3  |  Page : 228  

Lung ultrasound: A potential tool to detect lobar atelectasis


Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication2-Mar-2016

Correspondence Address:
Swapnil Y Parab
13, Periyar, Anushakti Nagar, Mumbai - 400 094, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.177874

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How to cite this article:
Parab SY, Divatia JV. Lung ultrasound: A potential tool to detect lobar atelectasis. Indian J Anaesth 2016;60:228

How to cite this URL:
Parab SY, Divatia JV. Lung ultrasound: A potential tool to detect lobar atelectasis. Indian J Anaesth [serial online] 2016 [cited 2020 Jan 23];60:228. Available from: http://www.ijaweb.org/text.asp?2016/60/3/228/177874

Sir,

We thank the authors for the comments on our article, where they have correctly pointed out the potential use of lung ultrasonography (LUSG) in confirmation of lobar atelectasis.[1],[2] Atelectasis in thoracic surgical patients is often the 'resorptive atelectasis'(RA) involving either the entire lung or a lobe of the lung depending upon the placement of lung isolation device. On LUSG, RA leads to immediate abolishment of lung sliding (LS) and appearance of lung pulse (LP). Later, it leads to a reduction in lung volume, and hepatisation of the lung, with presence of static air bronchograms. Static bronchograms can be differentiated from dynamic ones on M mode, where dynamic bronchograms are seen with inspiratory centrifugal shifts (sinusoidal sign). Dynamic air bronchograms that are seen in lung consolidation rule out RA. Thus, the presence of static air bronchogram and LP can reliably identify RA.[3]

However, there are some limitations in use of LUSG to detect RA in surgical patients. Presence of clavicle limits ultrasonographic visualization of upper lobes. LS and LP are more difficult to identify on anterior chest wall.[4] Use of large tidal volume leads to hyperinsufflation of ventilated lobes, producing LS sign and can miss atelectasis of other lobe.[4] As correctly mentioned by the commenter, LP sign is more commonly seen on left hemithorax than right. Detection of hepatisation of lung and air bronchogram requires additional time and technical skills. Hence, it is difficult to identify RA of a single lobe, especially on the right side. These could be the reasons why LUSG is found to be less sensitive in detecting right upper lobe isolation.[4] Use of colour Doppler modality can be helpful in cases of subtle sliding when direct visualization may be difficult (power slide sign).[5]

To sum up, we agree with the commentor that combination of LS, LP, static air bronchograms, diaphragmatic motion and power slide sign can improve the accuracy of LUSG in identifying lobar atelectasis in the hands of experts. However, more studies are needed in this aspect.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Diaz NGA. “A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries”. Indian J Anaesth 2016;60:226-7.  Back to cited text no. 1
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2.
Parab SY, Divatia JV, Chogle A. A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries. Indian J Anaesth 2015;59:476-81.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Lichtenstein D, Mezière G, Seitz J. The dynamic air bronchogram. A lung ultrasound sign of alveolar consolidation ruling out atelectasis. Chest 2009;135:1421-5.  Back to cited text no. 3
    
4.
Ponsonnard S, Karoutsos S, Gardet E, Marsaud JP, Nathan N. Value of lung sonography to control right-sided double lumen endotracheal location. J Anesth Clin Res 2014;5:453.  Back to cited text no. 4
    
5.
Husain LF, Hagopian L, Wayman D, Baker WE, Carmody KA. Sonographic diagnosis of pneumothorax. J Emerg Trauma Shock 2012;5:76-81.  Back to cited text no. 5
[PUBMED]  Medknow Journal  



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[Pubmed] | [DOI]



 

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