Suggestion for Classifying Air Artifacts




(1)
Hôpital Ambroise Paré Service de Réanimation Médicale, Boulogne (Paris-West University), France

 



Some artifacts are useless, others life-saving. The idea of suppressing all of them without discrimination is questionable. Technologies which will keep lung rockets alive will obviously keep alive the others, therefore, this short chapter. It intends to clarify the minds, describing all what can be encountered in the human being. Nothing is completely simple in medicine, and we aimed, in alphabetical order but some logic too, at decreasing the effort of memory. Remember that only two have a major clinical relevance, A-lines and B-lines (Fig. 40.1):

A322809_1_En_40_Fig1_HTML.gif


Fig. 40.1
Filiation between comet-tail, B-lines, and lung rockets. The main thoracic artifacts. This figure shows the scientific filiation between names sometimes confused in the brains. Lung rockets are a certain kind of B-lines. The B-line is a certain kind of comet-tail artifact. This figure aims at showing that lung ultrasound is a simple discipline, where confusions should not exist once the field has been standardized




  • A-lines (A for the first letter)



    • Lung



      • Horizontal hyperechoic artifacts arising from the pleural line at regular intervals which are equal to the skin-pleural line distance – indicating physiologic gas as well as free gas– as shown in Chap. 9.


      • A1, A2, etc., lines: Number of A-lines arising from the pleural line (not a very useful data).


  • B-lines (B for the second letter, also because this label is culturally linked to interstitial syndrome for the past 80 years. We specify in fact “ultrasound B-lines”) shown in Chap. 11



    • Lung



      • Artifacts defined according to seven criteria:

        A.

        Constant criteria:

        1.

        Comet-tail artifacts

         

        2.

        Arising from the pleural line

         

        3.

        Moving with lung sliding

         

         

        B.

        Almost constant criteria:

        4.

        Well defined, laser beam-like

         

        5.

        Long, not fading

         

        6.

        Erasing A-lines

         

        7.

        Hyperechoic (like the pleural line)

         

         




      • b-line: one B-line visible between two ribs. The term b-line is always singular.


      • bb-lines: two B-lines.


      • B+ lines: three or more B-lines, again, visible between two ribs.


      • Septal rockets (ex-B7-lines): B+ lines separated in adults by 6–7 mm, i.e., the distance between two interlobular septa (interlobular septal thickening). Between two ribs, usually 3 or 4 B-lines.


      • Ground-glass rockets (ex-B3-lines): B+ lines separated in adults by 3 mm, i.e., twice as many B-lines, possibly explained by extreme cases of interstitial syndrome. They are correlated with CT ground-glass lesions.


      • Birolleau variant: so many B-lines that the Merlin’s space appears homogeneously hyperechoic.


      • Sub-B-lines: see below.


  • C-lines (like centimetric cupuliform consolidation) shown in Chap. 17



    • Lung, real image (the exception in this chapter)



      • Curvilinear centimetric piece of alveolar consolidation abutting the pleural line. “Pleural-based” small lung consolidation, in other words.


  • D-lines



    • Available space


  • E-lines (for emphysema) shown in Chap. 14



    • Subcutaneous tissues



      • Comet-tail artifacts laser-like, hyperechoic, and spreading to the edge of the screen, but arising not from the pleural line, but from a hyperechoic line horizontally located above the pleural line (erased by these E-lines). Stripe of subcutaneous emphysema. No bat sign is visible: we are not in lung ultrasonography.


  • F-lines (from Fabien Rolland, a CEURFer)

May 4, 2017 | Posted by in CRITICAL CARE | Comments Off on Suggestion for Classifying Air Artifacts

Full access? Get Clinical Tree

Get Clinical Tree app for offline access