![]() Several clinical, radiological, and non-imaging methods are currently used for evaluating pulmonary fluid retention, but they are late and inaccurate (physical examination), insensitive and imprecise (chest X-ray), too complex for real time, repeated measurements in sick patients (computerized tomography), or inadequately validated and not widely available (conductance measurements with cardiac devices). Therefore, the possibility to image pulmonary oedema at a sub-clinical stage remains an attractive and elusive goal. Post-discharge freedom from pulmonary congestion is associated with a better prognosis. B-lines can be evaluated anywhere (including extreme environmental conditions with pocket size instruments to detect high-altitude pulmonary oedema), anytime (during dialysis to titrate intervention), by anyone (even a novice sonographer after 1 h training), and on anybody (since the chest acoustic window usually remains patent when echocardiography is not feasible).ĭetection and treatment of pulmonary congestion before it is clinically evident can prevent hospitalization and progression of heart failure. Wet B-lines are made by water and decreased by diuretics, which cannot modify dry B-lines made by connective tissue. The number and spatial extent of B-lines on the antero-lateral chest allows a semi-quantitative estimation of EVLW (from absent, ≤5, to severe pulmonary oedema, 30 B-lines). Increasing EVLW accumulation changes the normal, no-echo signal (black lung, no EVLW) into a black-and-white pattern (interstitial sub-pleural oedema with multiple B-lines) or a white lung pattern (alveolar pulmonary oedema) with coalescing B-lines. Lung ultrasound shows B-lines, comet-like signals arising from a hyper-echoic pleural line with a to-and-fro movement synchronized with respiration. In pulmonary congestion however, the presence of both air and water creates a peculiar echo fingerprint. ![]()
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