Pulmonary infarction: sonographic appearance with pathologic correlation

doi:10.1016/0720-048X(93)90098-8

European Journal of Radiology

Volume 17, Issue 3, November 1993, Pages 170-174

https://doi.org/10.1016/0720-048X(93)90098-8 Get rights and content

Abstract

Objective: Peripheral pulmonary lesions are detectable by ultrasound, the aim of this study was to compare sonograms of pulmonary infarctions with their pathological reports. Subjective: A total of 26 lung infarcts in 15 non-fixed autopsy lungs of patients showing necroscopically pulmonary embolism were examined sonographically in a water-bath no later than 5 h after autopsy with a 5- or 7.5-MHz sector scanner. Five of these patients were suspected of pulmonary embolism and underwent sonographic examinations shortly before their death. Results: Ultrasound showed mainly wedge-shaped (n = 18), hypoechoic areas. Their location, form and size corresponded exactly with pathological findings. Fresh infarcts were homogeneous and more hypoechoic. Older infarcts were well demarcated and showed a hyperechoic reflex in the center corresponding to the bronchiole; this was a sign of segmental involvement. In two cases it was possible to differentiate thromboembolically congested afferent blood vessel directed to the hilus. Ultrasound images from five living patients were similar to the image of the autopsy lung. Conclusion: In accordance with clinical studies these observations suggest that transthoracic sonography can be an efficient technique in the detection of pulmonary infarction, as well in an early reperfusionable stage as in distinguished infarct formation.

References (23)

OL Pedersen et al.
A fine needle aspiration biopsy of mediastinal and peripheral pulmonary masses guided by real-time sonography
Chest
(1986)
JA Pang et al.
Ultrasound guided tissue-core biopsy of thoracic lesions with trucut and surecut needles
Chest
(1987)
KM Moser
Venous thromboembolism
Am Rev Respir Dis
(1990)
PIOPED Investigators Value of the ventilation/perfusion scan in acute pulmonary embolism
JAMA
(1990)
CR Joyner et al.
Reflected ultrasound in the detection of pulmonary embolism
Trans Assoc Am Phys
(1966)
LD Miller et al.
Clinical use of ultrasound in the early diagnosis of pulmonary embolism
Ann Surg
(1967)
FW Budder et al.
Experimental and clinical experiences in the use of ultrasound for the early detection of pulmonary embolism: a preliminary report
Med J Aust
(1969)
G Mathis et al.
Pulmonary infarcts are detectable by ultrasound
Ultraschall in Med
(1990)
U Kroschel et al.
Sonographic detection of pulmonary embolism — results of a prospective study
Ultraschall in Med
(1991)
G Mathis et al.
Sonographic observation of pulmonary infarction and early infarctions by pulmonary embolism
Eur Heart J
(1993)

S Izumi et al.

Ultrasonically guided aspiration needle biopsy in diseases of the chest

Am Rev Respir Dis

(1982)

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Pulmonary infarction: sonographic appearance with pathologic correlation

Abstract

Chest

Chest

Venous thromboembolism

Am Rev Respir Dis

PIOPED Investigators Value of the ventilation/perfusion scan in acute pulmonary embolism

JAMA

Reflected ultrasound in the detection of pulmonary embolism

Trans Assoc Am Phys

Clinical use of ultrasound in the early diagnosis of pulmonary embolism

Ann Surg

Experimental and clinical experiences in the use of ultrasound for the early detection of pulmonary embolism: a preliminary report

Med J Aust

Pulmonary infarcts are detectable by ultrasound

Ultraschall in Med

Sonographic detection of pulmonary embolism — results of a prospective study

Ultraschall in Med

Sonographic observation of pulmonary infarction and early infarctions by pulmonary embolism

Eur Heart J

Ultrasonically guided aspiration needle biopsy in diseases of the chest

Am Rev Respir Dis