The Meaning of Thoracic Sonography in Diagnosis of Pulmonary Congestion due to Heart Failure

Goal: Pulmonary congestion is useful marker of decompensated congestive heart failure (CHF). The goal of the study was to evaluate the changes of pulmonary sonogram in patients with heart failure.

Methods: We studied 215 patients with heart diseases  who had different grade CHF and X-ray signs of pulmonary congestion (I group) and 74 normal persons and patients with heart diseased who had no signs of heart failure (II group). Sonographic evaluation of a lung was done in horizontal and vertical positions of patient, from 12 points of thoracic wall which corresponded to the projection of lower, middle and upper lobes of a right lung and upper and lower lobes of left lung.

Results: In patients with CHF we significantly often found the one of the sorts of reverberation phenomenon - “Comet tail Phenomenon” (CTP) (96,3% versus 34,2%, p<,0,001). In HF group CTP was registered from 6 or more points in 91,6% of patients. In control group it was registered from 3 or less points in 97,3% of patients. If wee take registration of a CTP from 4 and more points as a reference value the sensitivity of symptom in diagnosing of CHF is 0,94, specifyty – 0,97, accuracy – 0,95.  There was good correlation between the count of CTP registration points from the thoracic wall and the heart failure NYHA class (r=0.56. In CHF group CTP was prominent, protracted and multiple while in the II group it was single and short lasting.

Conclusion: Thoracic US is sensitive and accurate method for evaluation pulmonary congestion in patients with CHF. The US sign of pulmonary congestion in HF is a “Comet tail phenomenon”, which is protracted, prominent, multiple and registered from larger area of thoracic wall (4 points or more).