Real-Time Ultrasound-Guided Pleural Procedures

Advancements in technology over the last several years have allowed for the development of portable ultrasound units that can provide real-time, point-of-care assessment for a variety of diseases as well as guide diagnostic and therapeutic procedures. The use of ultrasound to guide pleural procedures requires a basic understanding of the physics and principles of ultrasonography, the knobology of the specific ultrasound unit being used, as well as skills in image acquisition and image interpretation. In addition to these skills, the operator must also be expert at performing the procedure without ultrasound guidance, and then develop the psychomotor coordination to perform the skills using ultrasound guidance. This chapter will review the use of ultrasound to guide pleural procedures. Even in the hands of trained pulmonologists, supposedly experts of these procedures and the thoracic physical exam, the use of ultrasound is associated with a significant reduction in near misses (i.e. inadvertent puncture of the lung or subdiaphragmatic organs) as well as improved success rates.1, 2 Given the strength of the literature regarding ultrasound and pleural disease, the current recommendations from the British Thoracic Society recommend the use of ultrasound to guide pleural interventions, including thoracentesis and tube thoracostomy.3.