Mapping Bullous Emphysema With Lung Ultrasound: A Prospective Multicentre Study.

IF 6.3 2区医学 Q1 RESPIRATORY SYSTEM Respirology Pub Date : 2025-07-01 Epub Date: 2025-03-09 DOI:10.1111/resp.70021

Kinan El Husseini, Thomas Flament, Sophie Laroumagne, Damien Basille, Mathilde Le Brun, Elise Noël-Savina, Philippe Richard, Gilles Mangiapan, Elise Artaud-Macari

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Abstract

Background and objectives: Lung ultrasound holds high diagnostic performance for pleural diseases, notably pneumothorax. Bullous emphysema is a potential differential diagnosis of pneumothorax on ultrasound, but its precise semiology is poorly known. This study aimed to delineate the sonographic presentation of bullous emphysema and assess the diagnostic performance of common ultrasound features in identifying bullae.

Methods: From June 2019 to June 2021, patients with CT scanner-confirmed bullous emphysema were prospectively included. Investigators performed a standardised 14-region lung ultrasound. Sonographic features of bullous and non-bullous regions were compared. Diagnostic performances for bullae were calculated for each sign, and an additive score was constructed using signs with specificity > 85%. Pearson's correlation was used to examine the relationship between this score, bulla size, and respiratory functional parameters.

Results: Thirty-six patients were included, mostly male (n = 33 patients, 91.7%), with an average age of 62 ± 11 years. Bullae mostly affected apical regions (n = 24 patients, 67%). Bullous regions displayed a more frequent absence of lung sliding (34% vs. 11% in non-bullous regions, p < 0.01), barcode sign (15% vs. 3%, p < 0.01), increased A-line visibility (16% vs. 8%, p = 0.048), and absence of Z lines (62% vs. 44%, p = 0.018). A bulla-point sign was visualised in 4% of bullous regions. Absent lung sliding was more frequent in patients with pulmonary distension and in apical regions. Patient bulla score (3 [2-6]) correlated with bulla size (r = 0.53 [0.25;0.73], p < 0.001), FEV₁ (r = -0.38 [-0.60;-0.03], p = 0.022), and forced vital capacity (r = -0.38 [-0.64;-0.08], p = 0.021).

Conclusion: Our findings challenge previous data about the specificity of ultrasound signs of pneumothorax in patients with bullous emphysema, highlighting the need for cautious interpretation in clinical practice.

Trial registration: NCT04012359.

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肺超声定位大疱性肺气肿：一项前瞻性多中心研究。

背景和目的：肺超声对胸膜疾病，尤其是气胸具有很高的诊断价值。大疱性肺气肿是气胸的潜在鉴别诊断，但其精确的符号学尚不清楚。本研究旨在描述大疱性肺气肿的超声表现，并评估常见超声特征在识别大疱性肺气肿中的诊断性能。方法：前瞻性纳入2019年6月至2021年6月CT扫描确诊的大疱性肺气肿患者。研究人员进行了标准化的14区肺超声检查。比较大泡区和非大泡区超声特征。计算每个征象对大疱的诊断性能，并使用特异性> 85%的征象构建相加评分。Pearson相关性用于检验该评分、大球茎大小和呼吸功能参数之间的关系。结果：纳入36例患者，男性居多（n = 33例，占91.7%），平均年龄62±11岁。大疱主要累及根尖区域（n = 24例，67%）。大泡区肺无滑动（34%比11%，p = 0.022）和肺活量（r = -0.38 [-0.60;-0.03], p = 0.022）更为常见。结论：我们的研究结果挑战了先前关于大疱性肺气肿患者气胸超声征象特异性的数据，强调了在临床实践中谨慎解释的必要性。试验注册：NCT04012359。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respirology 医学-呼吸系统

CiteScore

10.60

自引率

5.80%

发文量

225

审稿时长

1 months

期刊介绍： Respirology is a journal of international standing, publishing peer-reviewed articles of scientific excellence in clinical and clinically-relevant experimental respiratory biology and disease. Fields of research include immunology, intensive and critical care, epidemiology, cell and molecular biology, pathology, pharmacology, physiology, paediatric respiratory medicine, clinical trials, interventional pulmonology and thoracic surgery. The Journal aims to encourage the international exchange of results and publishes papers in the following categories: Original Articles, Editorials, Reviews, and Correspondences. Respirology is the preferred journal of the Thoracic Society of Australia and New Zealand, has been adopted as the preferred English journal of the Japanese Respiratory Society and the Taiwan Society of Pulmonary and Critical Care Medicine and is an official journal of the World Association for Bronchology and Interventional Pulmonology.