Non-invasive assessment and clinical importance of the extravascular lung water in heart failure: the B-lines
Ágoston Gergely1, Jambrik Zoltán2, 3
1Szegedi Tudományegyetem, Általános Orvostudományi Kar, Családorvosi Intézet, Szeged
2Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
3Békés Megyei Pándy Kálmán Kórház, Gyula
Pulmonary congestion is a common and important pathophysiological finding in heart failure. It has a key feature in the management and prognosis of patients with heart failure. The lung parenchyma examination has been traditionally considered limited for ultrasound techniques due to the fact that ultrasound energy is rapidly dissipated in air. However, the presence of water in the lungs opens up the pulmonary acoustic window and allows to examine the lung parenchyma. B-lines may be more familiar for radiologists, known as radiological Kerley B-lines, a sign of extravascular lung water on chest X-ray. In pulmonary congestion the lung ultrasound shows B-lines, which are comet-like signals arising from a pleural line with a movement synchronized with respiration. The assessment of the number and spatial extent of B-lines on the antero-lateral chest wall is useful for the identification of subclinical and symptomatic congestion, with high sensitivity and excellent specificity. Lung ultrasound also provides useful information in the management and prognosis for patients with heart failure. Lung ultrasound is an excellent diagnostic opportunity for the cardiologist. It is feasible, radiation free, low cost, can be done at bedside and allows non-invasive detection, in real time of pulmonary congestion.