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B-Mode Ultrasound Findings in a Patient With Suspected Pulmonary Gangrene

Echivard, Mathieu MD1; Lichtenstein, Daniel A. MD, FCCP2; Lala, Adrian MD3; Sanchez, Anais Perez MD3; Girerd, Nicolas MD, FCCP4

doi: 10.1097/CCM.0000000000003913
Online Case Report

Objectives: Lung ultrasound has shown increasing diagnostic value in many lung diseases and has become an efficient tool in the management of dyspnea. In the present case report, we describe a new ultrasound feature of potential interest.

Data Sources: Clinical observation of a patient.

Study Selection: Case report.

Data Extraction: Data were extracted from medical records, after obtaining consent from the patient’s family. Illustrations were extracted from the imaging software and a video device.

Data Synthesis: A 56-year-old man was admitted with pneumonia of adverse outcome. Lung ultrasound, a method increasingly considered as a bedside gold standard in critically ill patients due to its overwhelming advantages, was the only tool able to specify the lung injuries. We describe herein a distinctive sign unequivocally evoking a destructive process suggestive of pulmonary gangrene, a variant of the fractal sign combining a lung consolidation with an underlying heterogeneous free fluid.

Conclusions: Lung ultrasound may help highlight pulmonary gangrene, a poorly-known disease, with this new ultrasonographic description. The next step will be to ascertain the relation between this new ultrasound feature and pulmonary gangrene and to assess how this bedside diagnosis could impact the prognosis of the disease.

1Service de Cardiologie, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.

2Service de Réanimation Médicale, Hôpital Ambroise-Paré, Boulogne (Paris-Ouest), France.

3Service des Urgences, Hôpital Robert Pax, Sarreguemines, France.

4Université de Lorraine, INSERM, Centre d’Investigations Cliniques 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France.

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Dr. Lichtenstein received funding from Novartis (board fees) and honoraria from Boehringer and Servier. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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