B-lines: Transthoracic chest ultrasound signs useful in assessment of interstitial lung diseases

This prospective study was conducted to evaluate the value of sonographic B-lines [previously called ''comet tail artifacts''], which are long, vertical, well-defined, hyperechoic, dynamic lines originating from the pleural line in assessment of interstitial lung diseases [ILD] and compare them with the findings of chest high-resolution computed tomography [HRCT] and pulmonary function tests [PFTs]. Sixty-one patients with ILD underwent transthoracic lung ultrasound for assessment of the presence of B-lines and the distance between them. These findings were compared with that of chest HRCT [ground glass, reticular, nodular or honey combing] and PFT as forced vital capacity [FVC], total lung capacity [TLC], diffusion capacity for carbon monoxide [DLCO] and partial arterial oxygen pressure [PaO[2]]. All patients had diffuse bilateral B-lines. The distance between each of the two adjacent B lines correlated with the severity of the disease on chest HRCT where B3 [the distance was 3 mm] correlated with ground glass opacity and B7 [the distance was 7 mm] correlated with extensive fibrosis and honey combing. Also, the distance between B-lines inversely correlated with FVC [r = -0.848, P < 0.001], TLC [r = -0.664, P < 0.001], DLCO [r = -0.817, P < 0.001] and PaO2 [r = -0.902, P < 0.001]. B-lines that are lung Ultrasound signs seem to be useful in the assessment of ILD.

Discrimination between pleural thickening and minimal pleural effusion using color Doppler chest ultrasonography

The discrimination of pleural thickening from minimal pleural effusion may be difficult as both lesions appear as anechoic on grayscale ultrasound, hence, free of [echoes] does not confirm the presence of pleural fluid. To evaluate the value of color Doppler ultrasound in differentiating minimal pleural effusion that could be aspirated from pleural thickening and to compare it with grayscale ultrasound. This analytic cross-sectional study was done prospectively on 40 patients who presented with pleural based opacity in their chest radiographs compatible with minimal pleural effusion. Gray scale ultrasound was done for all patients then color Doppler ultrasound examination was applied to detect the presence or absence of fluid color sign. The presence or absence of pleural effusion was confirmed by aspiration of pleural fluid. The sensitivity of real time gray scale ultrasound in detecting minimal pleural effusion and differentiating it from pleural thickening was 95.5% while, specificity was 33%, and accuracy was 67%. The ability of ultrasound in discrimination of minimal pleural effusion from pleural thickening improved greatly by application of the color Doppler examination where the specificity of the method reached 100% while the sensitivity was 91% and accuracy was 95%. Application of color Doppler examination increases the accuracy of real time chest ultrasound to discriminate pleural thickening from minimal pleural effusion and hence color Doppler examination proved to be a useful diagnostic tool to real-time gray-scale ultrasound for diagnosis of minimal pleural effusion

Role of sleep endoscopy in obstructive sleep apnea syndrome

There are limited data about the role of sleep endoscopy in obstructive sleep apnea syndrome [OSAS]. The aim of this study was to evaluate the level, degree and shape of obstruction of the upper airway in patients with OSAS by sleep endoscopy and their relation to OSAS severity. Fifty consecutive patients with OSAS were prospectively enrolled in this cross sectional analytic study. All patients underwent history, a full night-attended polysomnogra-phy and sleep endoscopy. The degree of pharyngeal narrowing [grades I-IV] was evaluated at ret-ropalatal, retroglossal and hypopharyngeal levels. Shape of pharyngeal collapse was classified into circular, lateral or antero-posterior at retropalatal and retroglossal levels. Shape of the epiglottis was also observed. All patients showed multisegmental levels of obstruction. Moderate OSAS had a higher percentage of grade II obstruction but a lower percentage of grade I at hypopharyngeal level compared to mild OSAS [P < 0.05]. Also, in moderate OSAS, tongue base obstruction was 47.4% which was significantly higher comparing to mild OSAS [16.7%] [P < 0.05]. There was no significant difference between different grades of obstruction at all anatomical levels in polysomnograph-ic parameters. Omega shaped epiglottis was associated with the highest apnea hypopnea index, desaturation index, lowest average and minimum O[2] level. Sleep endoscopy is a useful tool for the assessment of level, degree and shape of the upper airway obstruction during sleep in OSAS and this could be helpful in preoperative evaluation. Presence of obstruction at hypopharyngeal level or tongue base obstruction is an indicator of OSAS severity

Evaluation of recently validated non- invasive formula using basic lung functions as new screening tool for pulmonary hypertension in idiopathic pulmonary fibrosis patients

A prediction formula for mean pulmonary artery pressure [MPAP] using standard lung function measurement has been recently validated to screen for pulmonary hypertension [PH] in idiopathic pulmonary fibrosis [IPF] patients. To test the usefulness of this formula as a new non invasive screening tool for PH in IPF patients. Also, to study its correlation with patients' clinical data, pulmonary function tests, arterial blood gases [ABGs] and other commonly used screening methods for PH including electrocardiogram [EGG], chest X ray [CXR], trans-thoracic echocardiography [TTE] and computerized tomography pulmonary angiography [CTPA]. Cross-sectional study of 37 IPF patients from tertiary hospital. The accuracy of MPAP estimation was assessed by examining the correlation between the predicted MPAP using the formula and PH diagnosed by other screening tools and patients' clinical signs of PH. There was no statistically significant difference in the prediction of PH using cut off point of 21 or 25 mm Hg [P= 0.24]. The formula-predicted MPAP greater than 25mm Hg strongly correlated in the expected direction with O[2] saturation [r = -0.95, P < 0.000], partial arterial O[2] tension [r = -0.71, P < 0.000], right ventricular systolic pressure measured by TTE [r = 0.6, P < 0.000] and hilar width on CXR [r = 0.31, P = 0.03]. Chest symptoms, EGG and CTPA signs of PH poorly correlated with the same formula [P > 0.05]. The prediction formula for MPAP using standard lung function measurements is a simple non invasive tool that can be used as TTE to screen for PH in IPF patients and select those who need right heart catheterization

Neuropsychological status and health related quality of life in patients with chronic obstructive pulmonary disease

A variety of neuropsychological factors may influence the quality of life of chronic obstructive pulmonary disease [COPD] patients beyond the extent of physical problems. This study aimed to investigate sub-clinical neuropsychological changes in patients with COPD; having different degrees of hypoxemia and their health related quality of life. the study included 54 COPD patients compared with 40 normal healthy volunteers matched for age and sex as controls. COPD patients included 21patients without respiratory failure [RF] [38.9%] and 33 patients with RF [61.1%]. All subjects underwent: study of Events Related Potentials [ERPs], Mini-Mental State Examination [MMSE], Kaufman Short Neuropsychological Assessment Procedure [K-SNAP] and Symptom Chick List-90-Revised [SCL-90-R]. Patients were subjected to, spirometry, blood gases, conventional wakeful electroencephalography [EEG], and St. George Respiratory Questionnaire [SGRQ] examination. Diffuse slowing in EEG reported in 54.5% of patients with RF and in 23.8% of patient without RF. There was a significant prolongation in P2L, N2L, and P3L in COPD patients without and with respiratory failure than controls; also, there was significant lower amplitude of P300 [P3A] in COPD patients with RF than the other groups. Both COPD patients without and with respiratory failure have mean total score and language score of MMSE significantly lower than the controls. The mean scores of Impairment Index on K-SNAP of COPD patients with and without RF were statistically significantly higher than the controls. Higher percentages of COPD patients with and without respiratory failure showed tendency to perform on the medium complex cognitive tasks better than the high complex cognitive tasks. COPD patients had significantly higher scores for many psychiatric symptoms than the controls and this was more remarkable among those with respiratory failure. Scores of all items of SCL-90-R were positively correlated to duration of COPD affection, severity of the disease and to different SGRQ components. COPD patients with RF have scores in all items of SGRQ significantly higher than those without RF. There were sub-clinical diffuse organic brain affection, associated with impairment of cognitive functions and many psychological troubles in COPD patients which were related to severity and duration of illness, which represent additional problems to physical effect of COPD, both reflecting more impairment in quality of life. So, early discovery and correction of these factors might help in improvement of quality of life of COPD patients