Chest ultrasound in diagnosis of pulmonary embolism

In many cases of pulmonary diseases extending up to the pleura, ultrasound helps to identify the etiology of the lesion. There are several sonomorphol ogical criteria to differentiate peripheral pulmonary consolidations. Clini cal studies and the sonographic appearance with pathologic correlation show ed pulmonary infarctions in location, form and size exactly corresponding w ith pathological findings. Fresh reperfusable infarcts were homogenous and hypoechoic. Older infarcts were well demarcated, mainly wedge shaped. Trian gular pleural based lesions, more roughly structured, were observed with a hyperechoic reflex in the center corresponding to the bronchiole: a sign of segmental involvement. The sensitivity of transthoracic ultrasound in diag nosis of pulmonary embolism was 86 to 94 %, the specificity 67 to 87 %, pos itive predictive value 55 to 92 %, negative predictive value 91 %, accuracy 73 to 91 %. In massive central lung embolism, both fresh and old infarctio ns are found. An imminent larger embolism can be predicted, for instance, i n a deep vein thrombosis. With one ultrasound system, we can "kill three bi rds with one stone": source, way and outcome of pulmonary embolism by bedsi de examination.