THE ONE-SIDED LIGHT LUNG ON A CHEST-X-RAY - A SONOGRAPHIC CHALLENGE

Because of a reduced or missing air content the one sided light lung c an be examined by ultrasound. The aim of this study was to determine t he value of ultrasound as a diagnostic tool for this condition. 30 con secutive patients with a one-sided white lung were examined by ultraso und. It was determined whether solid or liquid formations were present , whether an effusion was echogenic, hypoechogenic or if septations we re seen. Sonography was used for the evaluation of the lung parenchyma before and after needle puncture (increasing partial ventilation as a sign for compression atelectasis, decreasing ventilation as a sign fo r obturation atelectasis) and for the characterization of pleural tumo rous lesions. 24 of the 30 patients (80%) had a pleural effusion (15 e chogenic, 9 hypoechogenic, 14 with septations). 6 patients (20%) showe d a solid formation. In 12 of 24 cases (50%) with a pleural effusion a compression atelectasis was found, in 11 cases (46%) a obturation ate lectasis was seen and in one case a hyperechogenic effusion after pneu monectomy. Tumorous lesions were seen in 6 pateints. Indirect signs fo r a tumor (obturation atelectasis, echogenic/septated effusion) showed 28 patients (93%); a direct proof of a tumor (malignant cells in cyto logy, tumor visualization, pleural metastasis) could be shown in 17 pa tients (57%). Chest sonography is able to safely discriminate between solid and liquid formations and should be used before chest puncture o r biopsy. Because ultrasound adds considerable diagnostic information, the chest sonography should be used as a screening method in any case of a one-sided light lung on a chest X-ray.