Potentials of ultrasound diagnostic in pleural diseases

Uz konvencionalnu radiologiju kod bolesti pleure danas važnu ulogu imaju i drugi dijagnostički postupci. To su UZ i CT, dok MR ima ograničene mogućnosti. U članku se raspravlja o normalnom ultrazvučnom nalazu pleure i pleuralnog prostora te o njačešćim pleuralnim bolestima kao i o usporedbi s CT-nalazima. Ultrazvuk je važan i za razlikovanje nejasnih slučajeva, radi li se o promjenama pleure i/ili promjenama plućnog parenhima, kao i za razlikovanje subpulmonalnih, odnosno subfreničnih procesa. UZ se u ove svrhe može koristiti interkostalnim ili abdominalnim pristupom. Pleuralni izljevi su anehogeni ili hiperehogeni, razdvajaju visceralnu od parijetalne pleure pa se na temelju mjerenja te distancije može učiniti i kvantitativna procjena količine pleuralnog izljeva. Ako nije moguće razlikovati pleuralni izljev od solidnog tkiva u pleuralnom prostoru, može se učiniti UZ-vođena iglena punkcija. Ultrazvuk omogućava utvrđivanje difuznih i fokalnih zadebljanja te tumora pleure, odnosno metastaza kao i pneumotoraksa Posebno je važno napomenuti primjenu ultrazvuka u ciljanim dijagnostičkim ili terapijskim postupcima.Along with the conventional radiology, other diagnostic procedures also play significant role nowadays. Those diagnostic procedures are US and CT, whereas MR imaging has limited potentials. The article discusses normal ultrasound finding of pleura and pleural space and its comparison with CT-findings, as well as the most common pleural diseases. Ultrasound is also important for distinguishing between unclear cases, regardless whether it concerns alterations of pleura and/or alterations of pulmonary parenchyma, as well as the distinguishing between subpulmonary and subphrenic processes. For these purposes ultrasound can be used with intercostal or abdominal approach. Pleural effusions are anechogenic or hyperechogenic, they divide visceral pleura from parietal pleura, therefore, according to measurement of that distance a quantitative assessment/evaluation of amount of pleural effusion can be made. If it is not possible to distinguish pleural effusion from solid tissue in pleural space, ultrasound-guided needle puncture can be performed. Ultrasound enables detection of diffuse and focal thickenings, as well as pleural tumors, i.e. metastasis and pneumothorax. It is particularly important to mention the use of ultrasound in target diagnostic or therapeutic procedures