Transthoracic Lung Ultrasound in the Monitoring of Interstitial Lung Disease - Scleroderma Example

Natalia Buda ¹ Wojciech Kosiak ² Żaneta Smoleńska ¹ Zbigniew Zdrojewski ¹

¹Department of Internal Medicine, Connective Tissue Disease and Geriatrics, Medical University of Gdansk
²Unit of Ultrasound Diagnostic and Biopsy of the Department of Pediatrics Hematology and Oncology, Medical University of Gdansk

A 51- year-old woman with a diagnosis of interstitial lung disease in scleroderma was admitted to the Departmentof Internal Medicine, Connective Tissue Disease and Geriatrics,Medical University of Gdansk,Poland. Aim of this study is to show the monitoring of lung lesions in interstitial lung disease with transthoracic lung ultrasound (TLUS) in compare to the high resolution computed tomography (HRCT), before and after treatment with cyclophosphamide. The patient was hospitalized because of gradually increasing exertional dyspnea . The first HRCT study described fibrotic lesions mainly in the lower lobes and a ground glass sign in the middle fields of the lungs. In a TLUS visualized in the middle lung fields a white lung sign and regular pleural line (active form) and in the lower lobes irregular and blurred pleural line with coexist B-line artifacts (done alteration). TLUS was performed the same day as HRCT, the exams were described by two diagnosticians , and the results of both studies were consistent. In view of the clinical deterioration of pulmonary function and the presence of ground glass on HRCT the patient was qualified to I.V. cyclophosphamide therapy (1,0 g/monthly). After 6 months of treatment with cyclophosphamide control study was performed using LUS, HRCT and lung function test. HRCT has shown reduction severity of ground glass sign in the middle fields of the lungs). Equally, in the TLUS was observed a reduction of white lung sign and the appearance of A-line artifacts - normal image occurring in the lungs. In the lower lung fields in both imaging methods were presented worsening of pulmonary fibrosis.The pulmonary function tests showed improvement of respiratory parameters .The increasing number of publications have reported on the possibility of diagnosis of pulmonary fibrosis in the TLUS. This paper presents the possibility of simple and noninvasive imaging method to monitoring interstitial lung disease.

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