Transthoracic Ultrasonography for Clinicians

Transthoracic ultrasonography (US) has become an essential tool for respiratory, emergency and critical care physicians. As a modality for the evaluation of a wide range of thoracic pathologies it can be performed with basic equipment and by personnel with minimum training. Its advantages include immediate application at the point-of-care, low cost and lack of radiation. The main indications for transthoracic US are the qualitative and quantitative assessment of pleural effusions, pleural thickening, diaphragmatic pathology, as well as chest wall and pleural tumours. US is also useful in visualising pulmonary pathologies that abut the pleura, such as pneumonic consolidation and the interstitial syndromes including pulmonary oedema. Transthoracic US is more sensitive than the traditional chest radiograph in the detection of pneumothoraces, and is useful in diagnosing skeletal abnormalities like rib fractures. It is the ideal tool to guide transthoracic procedures, including thoracocentesis and pleural biopsy. Moreover, US-guided procedures can be performed by a single clinician with no sedation and minimal monitoring. US-guided fine needle aspiration and/or cutting needle biopsy of extrathoracic lymph nodes, and lesions arising from the chest wall, pleura, peripheral lung and mediastinum are safe and have a high yield in the of hands of experienced clinicians. US can potentially also guide aspiration and biopsy of diffuse pulmonary infiltrates, consolidations and lung abscesses. Moreover, transthoracic US may be used in the detection of pulmonary embolism.