Skip to main content

Role of transthoracic ultrasound in evaluating patients with chronic obstructive pulmonary disease

Abstract

Background

Conventional ultrasound with frequencies ranging from 2 to 10 MHz is increasingly used for the diagnosis of pulmonary diseases including pneumothorax, pleural effusion, alveolar–interstitial syndrome, and lung consolidation. Transthoracic ultrasound (TTUS) can be useful in evaluating diaphragmatic function, air trapping, and A lines for the assessment of patients with chronic obstructive pulmonary disease (COPD) and differentiation from other mimicking conditions.

Aim

This study was carried out to assess the role of TTUS in evaluating patients with COPD.

Patients and methods

This was a prospective study carried out on 60 male participants: 40 of them were COPD patients (cases) and 20 were healthy individuals (controls). All cases were examined by TTUS B-mode, low-frequency and highfrequency transducer to detect the regularity of the pleura lines and the prominence of A lines, and all of them were examined by M-mode to assess diaphragmatic excursion.

Results

There was a statistically significant difference with regard to irregularity of pleura lines and prominence of A lines between COPD and control groups with a P value less than 0.001. Regarding diaphragmatic excursion, there was a statistically significant difference between the two groups (P <0.001). A cut-off value of 2.95cm for diaphragmatic excursion was assigned with 83.7% sensitivity and 70.6% specificity to differentiate mild and moderate COPD from severe and very severe cases.

Conclusion

TTUS is a helpful tool for evaluating COPD patients and for assessing disease severity.

References

  1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: executive summary; 2015. Available at: http://www.goldcopd.org/. Accessed at 25 Feb 2016.

  2. Volpicelli G. Lung sonography. J Ultrasound Med 2013;32:165–171.

    Article  Google Scholar 

  3. Colmenero M, García-Delgado M, Navarrete I, López-Milena G. Utility of the lung ultrasound in the intensive medicine unit. Med Intensiva 2010;34:620–628.

    Article  CAS  Google Scholar 

  4. Wu TS. Ultrasound, an issue of critical care. Crit Care Clin 2014;30:1–84.

    Article  CAS  Google Scholar 

  5. Burge S, Wedzicha JA. COPD exacerbations: definitions and classifications. Eur Respir J Suppl 2003;41:46s–53s.

    Article  CAS  Google Scholar 

  6. Jones RC, Donaldson GC, Chavannes NH, Kida K, Dickson-Spillmann M, Harding S et al. Derivation and validation of a composite index of severity in chronic obstructive pulmonary disease: the DOSE index. Am J Respir Crit Care Med 2009;180:1189–1195.

    Article  Google Scholar 

  7. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013;187:347–365.

    Article  CAS  Google Scholar 

  8. Cobbold C, Richard S. Foundations of biomedical ultrasound. Canada: Oxford University Press; 2007. 422–423. ISBN 978-0-19-516831-0.

    Google Scholar 

  9. Koh DM, Burke S, Davies N, Padley SP. Transthoracic US of the chest: clinical uses and applications. Radiographics 2002;22:e1.

    Article  Google Scholar 

  10. Chan YH. Biostatistics 102: quantitative data − parametric & nonparametric tests. Singapore Med J 2003;44:391–396.

    CAS  Google Scholar 

  11. Ottenheijm CA, Heunks LM, Sieck GC, Zhan WZ, Jansen SM, Degens H et al. Diaphragm dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005;172:200–205.

    Article  Google Scholar 

  12. Gerscovich EO, Cronan M, McGahan JP, Jain K, Jones CD, McDonald C. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 2001;20:597–604.

    Article  CAS  Google Scholar 

  13. Testa A, Soldati G, Giannuzzi R, Berardi S, Portale G, Gentiloni Silveri N. Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects. Ultrasound Med Biol 2011;37:44–52.

    Article  Google Scholar 

  14. Sperandeo M, Varriale A, Sperandeo G, Filabozzi P, Piattelli ML, Carnevale V et al. Transthoracic ultrasound in the evaluation of pulmonary fibrosis: our experience. Ultrasound Med Biol 2009; 35:723–729.

    Article  Google Scholar 

  15. Buda N, Piskunowicz M, Porzezińska M, Kosiak W, Zdrojewski Z. Lung ultrasonography in the evaluation of interstitial lung disease in systemic connective tissue diseases: criteria and severity of pulmonary fibrosis: analysis of 52 patients. Ultraschall Med 2015; [ahead of print].

  16. Light RW. Pleural diseases. Vol. 1. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2007.

    Google Scholar 

  17. Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care 2014;4:1.

    Article  Google Scholar 

  18. Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008;134:117–125.

    Article  Google Scholar 

  19. Zhou S, Zha Y, Wang C, Wu J, Liu W, Liu B. The clinical value of bedside lung ultrasound in the diagnosis of chronic obstructive pulmonary disease and cardiac pulmonary edema. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2014;26:558–562.

    PubMed  Google Scholar 

  20. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009;135:391–400.

    Article  Google Scholar 

  21. Dos Santos Yamaguti WP, Paulin E, Shibao S, Chammas MC, Salge JM, RibeiroM et al. Air trapping: The major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients. Respirology 2008; 13:138–144.

    Article  Google Scholar 

  22. Paulin E, Yamaguti WP, Chammas MC, Shibao S, Stelmach R, Cukier A, Carvalho CR. Influence of diaphragmatic mobility on exercise tolerance and dyspnea in patients with COPD. Respir Med 2007;101:2113– 2118.

    Article  CAS  Google Scholar 

  23. Aka Aktürk U, çaglayan BN, Fidan A, Salepçi B, Turan D, Sener Cömert S et al. The evaluation of diaphragmatic motion by M-mode ultrasonography in chronic obstructive lung diseases. Eur Respir J 2013;42 (Suppl 57):1922.

    Google Scholar 

  24. Gorman RB, McKenzie DK, Butler JE, Tolman JF, Gandevia SC. Diaphragm length and neural drive after lung volume reduction surgery. Am J Respir Crit Care Med 2005;172:1259–1266.

    Article  Google Scholar 

  25. Oancea C, Fira-Mladinescu O, Crisan A, Tudorache E, Somesan A, Bertici N et al. Diaphragmatic muscle ultrasound in COPD patients. Eur Respire J 2014;44(Suppl 58):802.

    Google Scholar 

  26. Scheibe N, Sosnowski N, Pinkhasik A, Vonderbank S, Bastian A. Sonographic evaluation of diaphragmatic dysfunction in COPD patients. Int J Chron Obstruct Pulmon Dis 2015;10:1925–1930.

    PubMed  PubMed Central  Google Scholar 

  27. Kang HW, Kim TO, Lee BR, Yu JY, Chi SY, Ban HJ et al. Influence of diaphragmatic mobility on hypercapnia in patients with chronic obstructive pulmonary disease. J Korean Med Sci 2011;26:1209–1213.

    Article  Google Scholar 

  28. Baria MR, Shahgholi L, Sorenson EJ, Harper CJ, Lim KG, Strommen JA et al. B-mode ultrasound assessment of diaphragm structure and function in patients with COPD. Chest 2014;146:680–685.

    Article  Google Scholar 

  29. Kantarci F, Mihmanli I, Demirel MK, Harmanci K, Akman C, Aydogan F et al. Normal diaphragmatic motion and the effects of body composition: determination with M-mode sonography. J Ultrasound Med 2004;23:255–260.

    Article  Google Scholar 

  30. Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: anatomy and function. Radiographics 2012;32: E51–E70.

    Article  Google Scholar 

  31. Sarwal A, Walker FO, Cartwright MS. Neuromuscular ultrasound for evaluation of the diaphragm. Muscle Nerve 2013;47:319–329.

    Article  Google Scholar 

  32. Kim WY, Suh HJ, Hong SB, Koh Y, Lim CM. Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Crit Care Med 2011;39:2627–2630.

    Article  Google Scholar 

  33. Numis FG, Morelli L, Bosso G, Masarone M, Cocozza S, Costanzo A et al. Diaphragmatic motility assessment in COPD exacerbation, early detection of non-invasive mechanical ventilation failure: a pilot study. Crit Ultrasound J 2014;6(Suppl 2):A6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ahmed M. Abd El Hafeez.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Youssuf, H.A.A., Abdelnabi, E.A., Abd El Hafeez, A.M. et al. Role of transthoracic ultrasound in evaluating patients with chronic obstructive pulmonary disease. Egypt J Bronchol 10, 274–282 (2016). https://doi.org/10.4103/1687-8426.193638

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.193638

Keywords

  • chronic obstructive pulmonary disease
  • diaphragmatic excursion
  • transthoracic ultrasound