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GINO SOLDATI
Direttore U.O. Pronto Soccorso - Medicina e Chirurgia di Accettazione e d’Urgenza
Ospedale della Valle del Serchio - ASL 2 - Lucca
ROBERTO COPETTI
Direttore S.O.C. Pronto Soccorso - Medicina d’Urgenza
Ospedale Latisana - Udine
THORACIC ULTRASOUND
C.G. EDIZIONI MEDICO SCIENTIFICHE s.r.l.
Via Piedicavallo, 14 – 10145 Torino
Tel. 011.33.85.07 – Fax 011.38.52.750
Sito web: www.cgems.it – E-mail: cgems.clienti@cgems.it
THORACIC ULTRASOUND
e cover is a courtesy of Giampietro Marchetti
ISBN 978-88-7110-421-8
Also available as an ebook:
eISBN 978-88-7110-396-9
To access to the original videoclips: http://www.cgems.it
e objective is to illustrate dynamic aspects of the lung, not easy to understand through photos
© 2015 C.G. Edizioni Medico Scientifiche s.r.l. Tutti i diritti riservati. Questo libro è protetto da Copyright.
Nessuna parte di esso può essere riprodotta, contenuta in un sistema di recupero o trasmessa in ogni forma
con ogni mezzo meccanico, di fotocopia, incisione o altrimenti, senza il permesso scritto dell’Editore.
Fotocopie per uso personale del lettore possono essere effettuate nel limiti del 15% di ciascun volume
dietro pagamento alla SIAE del compenso previsto dall’art. 68, comma 4, della Legge 22 aprile 1941 n.
633, ovvero dell’accordo stipulato tra SIAE, AIE, SNS e CNA CONFAR TIGIANATO, CASA, CLAAI,
CONFCOMMERCIO, CONFESERCENTI il 18 dicembre 2000.
Le riproduzioni per uso differente da quello personale potranno avvenire solo a seguito di spe cifica autorizzazione rilasciata dall’Editore.
Some of the product names, patents, and registered designs referred to in this book are in fact registered
trademarks or proprietary names even though specific reference to this fact is not always made in the text.
erefore, the appearance of a name without designation as proprie tary is not to be construed as a representation by the publisher that it is in the public domain.
is book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher’s consent is illegal
and liable to prosecution. is applies in particular to photostat reproduction, copying, mimeographing or
duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage.
Printed in Italy
e arguments against what is new usually evolve through
three distinct phases:
from “It is not true” to “It may be true, but it is not important”
to “It is true and it is important,
but it is not new: we have always known”.
Mother Nature did not attend high school geometry courses
or read the books of Euclid.
Her geometry is jagged, but with a logic
of its own and one that is easy to understand.
Nassim Nicholas Taleb, e black swan
e real voyage of discovery consists not
in seeking new landscapes,
but in having new eyes.
Marcel Proust, In search of lost time
2
Preface
Foreword
Chapter 1
Basic principles 1
Chapter 2
Anatomy of chest ultrasound 33
Chapter 3
Physics of chest ultrasound 49
Chapter 4
Semiotics of chest ultrasound 71
Index
Chapter 5
Pathology of the pleura 109
Chapter 6
Pneumothorax 133
Chapter 7
Parenchymal lung patology 147
Chapter 8
Pathology of the diaphragm 243
Chapter 9
oracic trauma 265
Chapter 10
Echocardiography 305
Chapter 11
Echodynamics 361
V
VI Index
Chapter12
Integrated clinical ultrasound in critically ill not traumatized patients.
A practical approach including lung ultrasound 383
Chapter 13
Pleural and lung ultrasound in the neonatal period and in childhood 403
Chapter 14
Interventional chest ultrasound 433
Chapter 15
oracic ultrasound settings 505
A1
Appendix 519
A2
Abbreviations 525
2
“oracic Ultrasound” has been published based on the second Italian edition of the book.
However it is not a simple reproduction in English of the Italian text. is book has been
entirely revised, updated and expanded, not only because of the rapid growth of clinical
knowledge about chest ultrasound, which would make any work incomplete, although
relatively recent.
e main reason is a new vision of thoracic ultrasound methodology, recently analyzed and
improved mainly by our group. According to this approach, ultrasound is seen as an absolutely
necessary integration of clinical reasoning, aimed at a better diagnostic accuracy and essential
for effective and economic monitoring procedures.
erefore, this book is not a text on imaging, but a clinical aid that, based on the principles
of ultrasound, can allow the clinicians working on critical respiratory patients or with hemodynamic instability, to improve their diagnostic, therapeutic, operational and monitoring
performance.
“oracic Ultrasound” was originally written and dedicated to Emergency physicians. From
the edition of 2006 till today, many other specialists have appreciated this method of investigation, applicable on any patient in any moment of their clinical pathway. e need and the
opportunity to expand a limited use of chest ultrasound has indicated different applications,
also useful for Pulmonologists, Internists, Pediatricians, Surgeons, Cardiologists. While being
especially useful for Critical Care and Emergency Phisicians, “oracic Ultrasond” was updated, including different applications not only linked to emergency. In these cases, employing
a specific terminology and semiotics, respectful of purely pneumological and internist clinics,
and integrated in the traditional radiological lexicon.
Even the physical basis of chest ultrasound, and especially of the lung, have been expanded
based on personal research, not for purely academic reasons, but to identify consistent terminology and application methods. We believe that this process will pave the way to new and
future knowledge and uses of ultrasound on tissues containing air.
e pathology of the diaphragm is presented in a chapter, absent in the previous editions,
particularly useful to Pulmonologists and physicians who deal with respiratory patients in
Intensive Care or Rehabilitation.
e chapter on ultrasound of the heart has been revised. It describes focused (or basic) applications in accordance with guidelines approved by Emergency Physicians, but also with
more advanced uses, more suitable to clinicians interested in a comprehensive bedside study
of cardiorespiratory patients or with unstable hemodynamics.
Preface
VII
VIII Ultrasound
As a complement to this section, a new chapter has been introduced, which accurately
describes the application of ultrasound to study altered hemodynamics, fundamental for
a comprehensive approach to the critically ill patient by expert sonographers, who want to
acquire more advanced knowledge.
e bibliography, already complete enough, has been updated with references (“updated
bibliography”) to publications appeared in the literature over the past three years. Some brief
notes in these sections summarize the content of these works and make it easier to acquire
recent knowledge.
Gino Soldati
Roberto Copetti
2
It is a great pleasure to introduce this highly innovative and useful textbook that reflected the
large clinical experience of the Authors and summarizes the state of the art and the standard of
care for the use of ultrasound in different clinical setting of critical care. is book highlights
the established knowledge, the evolving use and the new opportunities of this tool to maximise
the diagnostic information for clinical decision-making and for improving the patient care.
Chest integrated ultrasonography represents a fundamental advance of the physical examination of the patients. It has emerged in recent years as a very promising technique for the high
sensibility it has shown particularly in the detection of different lung and pleural pathological
states. Although ultrasound imaging may appear to be a complex technique, for the clinician
who has learned the different ultrasound patterns it is a valuable tool particularly for the first
approach of patients presenting with dyspnea and/or heart failure. Chest and heart ultrasound
examination, wisely integrated with clinical findings and biomarkers provides a quick and
cost effective answer to many clinical situations and it will be embraced by a growing number of practitioners and it will be progressively included into routine clinical practice. ere
is, therefore, a growing need for instruction in this new integrated approach to the patient.
is book has a central role in this transition, and will provide a wide range of clinicians with
a foundation for the practice of the skills necessary for diagnosing patients using ultrasound
and it will help to spread the expertise and knowledge currently available. e Editors, using
a clear and concise style along with effective illustrations, provide a timely definition of the
practice through their insight and experience. ey are among the first who have experienced a comprehensive training in ultrasound as part of their career and teaching activities.
is background makes the book highly effective in knowledge translation. As experienced
emergency physicians Dr. Soldati and Dr. Copetti make their point on the issue that matter
providing both capabilities and limitations of ultrasound examination.
I am sure that the readers will find this book a valuable resource and it will be useful to who
want to discover the fascinating world of ultrasound.
Foreword
Gianfranco Sinagra MD, FESC
Head of Cardiovascular Dept, University of Trieste and
Postgraduate School of Cardiology
IX
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