Editorial

Thoracic ultrasound at medical practice

0000-0002-0532-9273Miguel Angel Amaró Garrido^{1  *}  , 0000-0002-2335-048XNiurbys Mireya Morales Tamayo² 

¹Policlínico Universitario Área Centro Juana Naranjo León, Sancti Spíritus, Cuba.

²Hospital General Provincial Camilo Cienfuegos, Sancti Spíritus, Cuba.

At medical practice, the analysis of different diseases has come forward in the last few years, the patient's history, anamnesis and a prudent physical examination are the cornerstone for a correct diagnosis; however, one of the great changes in medicine has been the support of the different diagnostic methods with great technological advances, which have an important and accelerated development, changing without precedent, the different outcomes either in terms of morbidity, mortality or cost-effectiveness. ¹ The approach for the study of the different pleuropulmonary diseases is performed by imaging the thorax based on the simple posteroanterior radiography; however, it presents great limitations in the diagnostic precision of these diseases. The introduction of special imaging studies such as computerized axial tomography largely solved this problem, with the inconvenience of radiation doses and the inevitable transfer of the patient, ² In spite of, diagnostic ultrasound has been relevant up to date in different scenarios, having an impact on different health areas as an instrument that not only diagnoses but also maintains continuous monitoring in the management of patients, despite everything, it is not used enough for the definition and monitoring of the pleuropulmonary diseases. ¹

At the thoracic level, ultrasound has been used since the 60's of the 20th century. From that moment on, it has been a complementary procedure refering the other imaging methods used, such as plain radiographs, computerized axial tomography, nuclear magnetic resonance and scintigraphy; ³ Indications for its use include pleural, peripheral lung, mediastinal, diaphragmatic, and chest wall diseases. ⁴

At present, the diagnostic ultrasound has a series of advantages over the rest of imaging techniques, ⁵ among them the absence of ionizing radiation, the possibility of carrying out the examination at the patient's bedside, its evaluation in real time and the accessibility of the equipment as it can be repeated as many times as the patient needs it during the day, without this implying any increasing in the risks for the patients or for those who perform it. These characteristics are especially useful in people who are more susceptible to the adverse effects of radiation, such as children and pregnant women, or in patients with difficult mobility such as those admitted to intensive care units. The USD also allows observing the lung both in isolation, and in combination with its related organs, mainly in this case, the heart and the diaphragm. ^6,7

Ultrasound has had a secondary role in thoracic diseases because in the observation of the thorax with ultrasounds, it is difficult to explore the lung parenchyma due to artifacts that are the result of the interaction of ultrasound with the gaseous matter for which it is -mostly- composed the lung. Obviously, the study of the lung undoubtedly requires the learning of a very special language, so its usefulness is relevant due to all the benefits it offers. ⁶

In recent years, technical advances, such as the use of Doppler ultrasound, have made it possible to identify the vascular nature of pleuropulmonary lesions and in the diagnosis and management of patients in multiple subspecialties, like breast radiology and the locomotor system. ^8,9

There is also interventional ultrasonography, ¹⁰ which acquires a highlighted relevance in the study of thoracic masses, ¹¹ it constitutes an available tool in all Imaging services, easy to transport, which makes it indicated for procedures in patients located in intensive units or in the operating room, it is useful to guide procedures when the lesion is visible using this technique, it also does not use ionizing radiation, which is important in procedures that can be of long duration, it also allows real-time maneuvers with continuous control of the needle position. The time required for the different ultrasound-guided techniques is always much less than that required using other diagnostic means, and most procedures can be performed in a few minutes. It is a versatile tool that allows selecting multiple access routes to the lesion, it is not limited to a plan like other sectional techniques due to its high incidence, this makes it a necessary instrument today to arrive at a correct etiological diagnosis and consequently, to provide adequate treatment and an accurate prognosis of the disease, ultrasound guidance can be performed using devices adapted to the probes or through the freehand technique (holding the needle with a hand and the probe with the other). ¹²

In the author's opinion, thoracic ultrasound is an apparently complex and underused technique in the diagnosis and monitoring of diseases and other interventional procedures. Despite some limitations, it offers a series of advantages in the doctor-patient relationship such as accessibility, dynamism, speed, no use of ionizing radiation; it requires less time than other studies, which justifies its effectiveness. With the training and learning of the different ultrasound patterns, it constitutes a valuable tool for the study of thoracic diseases. It is in the hands of specialists getting advance in the knowledge of this practice and gradually integrates it into daily medical activity, so that knowledge of these possibilities should be part of everyone's heritage of competence.

REFERENCIAS BIBLIOGRÁFICAS

1.  García Araque HF, Aristizábal Linares JP, Ruíz Ávila HA. Semiología pulmonar por ultrasonido-monitorización dinámica disponible junto al paciente. Rev Colomb Anestesiol [Internet]. 2015 [citado 10 Jul 2020];43(4):290-8. Disponible en: Disponible en: https://www.elsevier.es/es-revista-revista-colombiana-anestesiologia-341-pdf-S0120334715000428 1.

2.  Colmenero M, García-Delgado M, Navarrete I, López-Milena G. Utilidad de la ecografía pulmonar en la unidad de medicina intensiva. Med Intensiva [Internet]. 2010 [citado 20 Jul 2020];34(9):620-8. Disponible en: Disponible en: http://scielo.isciii.es/pdf/medinte/v34n9/revision.pdf 2.

3.  Brismat Remedios I, Gutiérrez Rojas AR, Álvarez Mesa M, González Sosa G, Morales de la Torre R, Rodríguez Silva J. Eficacia del ultrasonido torácico realizado por cirujanos en el diagnóstico del trauma de tórax. Archivos del Hospital Universitario "General Calixto García" [Internet]. 2020 [citado 20 Jul 2020];8(1). Disponible en: Disponible en: http://www.revcalixto.sld.cu/index.php/ahcg/article/view/463 3.

4.  Osorio JA. Punción transtorácica guiada por ultrasonografía de lesiones pulmonares periféricas y mediastinales. Neumol Cir Torax [Internet]. 2012 [citado 20 Jul 2020];71(1):6-10. Disponible en: Disponible en: https://www.medigraphic.com/pdfs/neumo/nt-2012/nt121b.pdf 4.

5.  Jiménez Sánchez AF, Fernández Hernández CM, Gutiérrez Ramírez MC, Doménech Abellán E, Serrano García C, Gilabert Úbeda A. El papel de la ecografía en el diagnóstico y seguimiento de las consolidaciones pulmonares en el paciente pediátrico. [34 Congreso de la Seram Internet]. España: Sociedad Española de Radiología Médica; 2018. [citado 20 Jul 2020]. Disponible en: Disponible en: https://piper.espacio-seram.com/index.php/seram/article/view/813 5.

6.  Heili Sarah B, Peces-Barb G. Ecografía pulmonar. El nuevo estetoscopio del Neumólogo del siglo XXI. Medicina respiratoria [Internet]. 2014 [citado 2020 Jul 20];7(3):55-67. Disponible en: Disponible en: http://www.neumologiaysalud.es/descargas/R7/R73-7.pdf 6.

7.  Porcel JM. Ecografía pleural para clínicos. Rev Clín Esp [Internet]. 2016 [citado 20 Jul 2020];216(8):427-35. Disponible en: Disponible en: https://www.revclinesp.es/es-ecografia-pleural-clinicos-articulo-S0014256516300820 7.

8.  de la Quintana Gordon FB, Nacarino Alcorta B. Ecografía pulmonar básica. Parte 1. Ecografía pulmonar normal y patología de la pared torácica y la pleura. Rev Esp Anestesiol Rean [Internet]. 2015 [citado 20 Jul 2020];62(6):322-36. Disponible en: Disponible en: https://www.elsevier.es/es-revista-revista-espanola-anestesiologia-reanimacion-344-articulo-ecografia-pulmonar-basica-parte-1--S0034935615000511 8.

9.  Gallego Gómez MP, García Benedito P, Pereira Boo D, Sánchez Pérez M. La ecografía torácica en la enfermedad pleuro-pulmonar. Radiología [Internet]. 2014 [citado 20 Jul 2020];56(1):52-60. Disponible en: Disponible en: https://www.elsevier.es/es-revista-radiologia-119-articulo-la-ecografia-toracica-enfermedad-pleuro-pulmonar-S0033833812001403 10 9.

10.  Garduño‑López AL, Guizar‑Rangel T, Torres‑Muñoz FE, Urrea‑Valdez BML, Sarabia‑Collazo ÁA, Silva‑Gómez OF, et al. Intervencionismo guiado por ultrasonido en cirugía torácica y pared abdominal. Rev Mex Anest [Internet]. 2019 [citado 20 Jul 2020];42(3):234. Disponible en: Disponible en: https://www.medigraphic.com/pdfs/rma/cma-2019/cma193zn.pdf 10.

11.  Cepeda Yumbo YM. Técnicas por ecografía torácica para punción y drenaje de conexiones liquidas en el hospital Pablo Arturo Suarez en el periodo febrero - agosto del 2015. [Tesis de Titulación previo a la Obtención del Título de Licenciada en Radiología Internet]. Quito: Universidad Central del Ecuador-Facultad de Ciencias Médicas Carrera de Radiología ; 2016. [citado 20 Jul 2020]. Disponible en: Disponible en: http://www.dspace.uce.edu.ec/bitstream/25000/8218/1/T-UCE-0006-064.pdf 11.

12.  García-Ortega A, Briones-Gómez A, Fabregat S, Martínez-Tomás R, Martínez-García MÁ, Cases E. Utilidad de la ecografía en el diagnóstico de lesiones torácicas periféricas realizadas en una unidad de técnicas de neumología. Arch Bronconeumol [Internet]. 2016 [citado 20 Jul 2020];52(5):244-9. Disponible en: Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0300289615003208 12.

Received: July 28, 2020; Accepted: August 19, 2020

^*Autor para la correspondencia. Correo electrónico: [e-mail]

Los autores declaran no tener conflicto de interés en esta investigación.