الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
The conventional chest X-ray is still the first means of examination of the thorax, but not for pregnant women and children.
The indications for a chest sonogram include all the consolidations which might appear in radiography, and should be differentiated from effusion, atelectasis and tumors. All thoracic opacities, above all consolidations caused by effusions, should routinely be checked sonographically. However, the main application of chest sonogram is follow-up of pneumonic processes in general and particularly patients in ICU, pregnant Women and children .
This technique preferred for economic reasons, for reasons of radiation protection and due to the fact that ultrasonic devices are at hand even in the so-called developing countries all over the world.
The advantages of sonographic diagnosis:
• Non-invasive investigative process allowing the so-called bedside diagnosis, especially for patients in ICU,
• Excellent resolution in connection with sufficiently large field of view with good imaging of anatomic point of reference,
• Use of multiple cross sections,
• Immediate follow-ups in short intervals, because neither the patients nor the physician are exposed to radiation and the examination of seriously ill people can be carried out without moving the patient.
In the emergency room and in further acute cases, sonography of the thorax may prove vital and life-saving if performed at the bedside with due attention to the patient’s history.
Real-time ultrasound, including spectral Doppler and Color-Doppler imaging is an easy, quick and powerful tool for screening pulmonary sequestration, congenital cystic adenomatiod malformation and other intrathoracic lesions and dictating their further evaluation.
The use of ultrasound has proven effective in detecting lymph nodes and in analyzing some morphologic features that are frequently associated with malignancy.
US is a safe and effective guidance modality for transthoracic percutaneous biopsy of many thoracic lesions. US can be successfully used for biopsy of mediastinal, pleural, or even pulmonary masses.
Real-time visualization gives the operator the ability to monitor the position of the needle tip relative to the lesion at all times during the procedure. The most important resulting benefit was a significantly faster procedure time. US-guided biopsy allows needle placement and biopsy during a single breath hold, which decreases the time the needle stays across the pleura. This is particularly useful in small juxtadiaphragmatic masses.
US-guided biopsy requires less patient cooperation and can be successful even in sick, dyspneic patients. Minor patient movements are easily compensated for, so that the procedure can be successfully completed without the need for extra time to relocalize. Another distinct advantage of US-guided biopsy is that the procedure can be performed at the bedside in critically ill patients. ”Creative positioning” allows the procedure to proceed in a more comfortable fashion for the patient: We can perform US-guided thoracic biopsy in the semisitting position in patients with dyspnea who can not tolerate prone or supine positions. The decubitus position is also useful in patients with severe back pain or if there is a need to shift a pleural effusion to a favorable location.
We thus conclude that US of the chest should be tried in every patient who has a shadow in the plain X Ray that suggest the presence of a consolidation, effusion, atelectasis or a tumor.
It should also be the first line for needle guidance if a biopsy or aspiration is to be performed for an accessible lesion in the chest.