Lung ultrasound for the diagnosis of pneumonia in pregnant women with blood system tumors

Full Text

Abstract

Aim. To estimate the informative value of ultrasonography (USG) in the diagnosis of lung injuries in pregnant women with blood system tumors. Subjects and methods. Lung ultrasound was performed in 5 pregnant patients with blood cancers. The women's age was 29-38 years; gestational age was 14-33 weeks. Four women had different types of acute leukemia; one had primary mediastinal large B-cell lymphoma. All the women received chemotherapy for blood cancer. When there were signs of lung injury, USG was conducted, the results of which necessitated therapy or bronchoalveolar lavage (BAL). Results. Three patients developed acute respiratory failure; 2 of them required noninvasive ventilation. Based on the detection of consolidation with a dynamic air bronchogram and pleural effusion, the authors diagnosed bilateral pneumonia and alveolar-interstitial syndrome in 1 patient, right-sided pneumonia in 1, left-sided one in 1, and transfusion-related pulmonary edema in 1. Lung ultrasound did not verify the diagnosis of pneumonia in 1 patient. According to USG data, BAL procedures were performed in 2 patients; one of them was diagnosed as having Pneumocystis pneumonia; the other was found to have no pathogens in lavage fluid. Treatment resulted in clinical improvements and normalization of the lung ultrasound pattern in all the pregnant women. Later on, 4 women delivered via cesarean section done at 32-34 weeks' gestation and gave birth to healthy babies. One patient died from infectious complications after chemotherapy. Conclusion. Lung sound may be used to diagnose lung injury in pregnant women with blood cancers.

References

  1. Bodenham A.R. Ultrasound-Guided Vascular Access. In.: Hopkins P.M., Bodenham A. R., Reeves S.T. (ed). Practical Ultrasound in Anesthesia for Critical Care and Pain Management. N.Y.: Informa healthcare 2008: 51-71.
  2. Rapp H.-J., Folger A., Grau T. Ultrasound-Guided Epidural Catheter Insertion in Children. Anesth Analg 2005; 101 (2): 333-339.
  3. Griffin J., Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia 2010; 65 (1):1-12.
  4. Venkatakrishna R., Fletcher J.J., Lauryn R.R., Jacobs T.L. Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study. Crit Care 2011;15 (1): R67.
  5. Митьков В.В. Физика ультразвука. В кн.: Клиническое руководство по ультразвуковой диагностике. Под ред. В.В. Митькова. М: Видар 1996: 9-27.
  6. Овсянникова О.Б., Ананьева Л.П., Конева О.А. и др. Ультразвуковое сканирование: возможности и перспективы для оценки поражения легких при системнои? склеродермии. Науч-практ ревматол 2012; 6: 80-87.
  7. Lichtenstein D., Meziere G., Biderman P. et al. The Comet-tail Artifact An Ultrasound Sign of Alveolar-Interstitial Syndrome. Am J Respir Crit Care Med 1997; 156 (5): 1640-1646.
  8. Lichtenstein D.A., Mezie`re G.A. Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure. The BLUE Protocol. Chest 2008; 134 (1): 117-125.
  9. Xirouchaki N., Magkanas E., Vaporidi K. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med 2011; 37 (9): 1488-1493.
  10. Bouhemad B., Zhang M., Lu Q., Rouby J.J. Clinical review: Bedside lung ultrasound in critical care practice. Critical Care 2007; 11 (1): 205.
  11. Volpicelli G., Elbarbary M., Lichtenstein D.A. et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38 (4): 577-591.
  12. Нakimisefat B., Mayo P.H. Lung Ultrasonography. The Open Crit Care Med J 2010; 3: 21-25.
  13. Stefanidis K., Dimopoulos S., Tripodaki E.S. et al. Lung sonography and recruitment in patients with early acute respiratory distress syndrome: a pilot study. Critical Care 2011; 15 (4): R185.
  14. Савченко В.Г., Паровичникова Е.Н., Троицкая В.В. и др. Протокол лечения острых лейкозов у беременных. В кн.: Программное лечение заболеваний системы крови. Сборник алгоритмов диагностики и протоколов лечения заболеваний системы крови. Том II. Под ред. В.Г. Савченко. М: Практика 2012: 358-381.
  15. Balik M., Plasil P., Waldauf P. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med 2006; 32 (2): 318-321.
  16. Мальцева И.В., Паровичникова Е.Н. Рекомендации по интерпретации результатов иммунофенотипирования острых лейкозов. В кн.: Сборник протоколов и алгоритмов химиотерапии и сопроводительного лечения лейкозов, миелодисплазий и аплазий кроветворения. Том I. под ред. В.Г. Савченко. М: Русская книга 2008: 1-12.
  17. Галстян Г.М., Клясова Г.А., Городецкий В.М. Острая дыхательная недостаточность у больных в гематологической клинике. В кн.: Программное лечение заболеваний системы крови. Сборник алгоритмов диагностики и протоколов лечения заболеваний системы крови. Том II. Под ред. В.Г. Савченко. М: Практика 2012: 1011-1032.
  18. Fey M.F., Surbek D. Leukaemia and Pregnancy. В кн: Surbone A., Peccatori F., Pavlidis N. (ed). Cancer and Pregnancy 2008: 97-111.
  19. Shapira T., Pereg D., Lishner M. How I treat acute and chronic leukemia in pregnancy. Blood Rev 2008; 22: 247-259.
  20. Cardonick E., Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol 2004; 5: 283-291.
  21. Carradice D., Austin N., Bayston K., Ganly P.S. Successful treatment of acute promyelocytic leukaemia during pregnancy. Clin Lab Haematol 2002; 24 (5): 307-311.
  22. Yang D., Hladnik L. Treatment of acute promyelocytic leukemia during pregnancy. Pharmacotherapy 2009; 29 (6): 709-724.
  23. Троицкая В.В., Паровичникова Е.Н., Махиня С.А. и др. Лечение острого промиелоцитарного лейкоза на фоне беременности. Тер арх 2013; 10: 56-63.
  24. Orasch C., Weisser M., Mertz D. et al. Comparison of infectious complications during induction/consolidation chemotherapy versus allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2010; 45: 521-526.
  25. Lapinsky S.E. Obstetric Infections Crit Care Clin 2013; 29 (3): 509-520.
  26. Berkowitz K., LaSala A. Risk factors associated with the increasing prevalence of pneumonia during pregnancy. Am J Obstet Gynecol 1990; 163 (3): 981-985.
  27. Vargas S.L., Ponce C.A., Sanchez C.A. et al. Pregnancy and asymptomatic carriage of Pneumocystis jiroveci. Emerg Infect Dis 2003; 9 (5): 605-606.
  28. Ahmad H., Mehta N.J., Manikal V.M. et al. Pneumocystis carinii pneumonia in pregnancy. Chest 2001; 120 (2): 666-671.
  29. Parisaei M., Hemelaar J., Govind A. HIV in pregnancy: a case of Pneumocystis (carinii) jiroveci pneumonia Arch Gynecol Obstet 2010; 281: 1-3.
  30. Israel R., Dorer R., Aboulafia D.M. Case Report of Human Immunodeficiency Virus Infection, Hodgkin Lymphoma, and Pregnancy. Am J Med Sci 2010; 339 (2): 185-187.
  31. Мангасарова Я.К., Магомедова А.У., Кравченко С.К., Шмаков Р.Г. Диффузные В-крупноклеточные лимфосаркомы и беременность: терапевтическая тактика. Гематол трансфузиол 2011; 2: 18-20.
  32. ACOG Committee on Obstetric Practice. Guidelines for Diagnostic Imaging During Pregnancy. Obstet Gynecol 2004; 104 (3): 647-651.
  33. Готман Л.Н., Костина И.Э., Вишневская Е.С. и др. Возможности компьютерной томографии высокого разрешения в диагностике поражений легких после трансплантации костного мозга при заболеваниях системы крови Тер арх 2004; 4: 45-50.
  34. Bross I.D., Natarajan N. Genetic damage from diagnostic radiation. JAMA 1977; 237 (22): 2399-2401.
  35. Gruson D., Hilbert G., Vargas F. et al. Usefulness of computed tomography in early detection of pneumonia in leukopenic patients. Intensive Care Med 2001; 27: 444.
  36. Cunningham F.G., Gant N.F., Leveno K.J. et al. General considerations and maternal evaluation. In: Williams obstetrics. 21st ed. NY: McGraw-Hill 2001; 1143-1158.
  37. Сафонов Д.В., Шахов Б.Е. Ультразвуковая диагностика пневмоний. В кн.: Ультразвуковая диагностика воспалительных заболеваний легких. Под ред. Д.В. Сафонова, Б.Е. Шахова. М: Видар 2011: 31-67.
  38. Гришин А.М., Громов С.Г., Радова Н.Ф. и др. Ультразвуковое исследование легких для выявления внесосудистой жидкости у больного инфарктом миокарда с острой левожелудочковой недостаточностью. Кремлевская мед. Клин вестн 2010; 2: 55-57.
  39. Bouhemad В., Brisson H., Le-Guen M. et al. Bedside Ultrasound Assessment of Positive End-Expiratory Pressure-induced Lung Recruitment. Am J Respir Crit Care Med 2011; 183: 341-347.
  40. Shen P., Zong Y., Shu J. et al. Dynamic assessment of lung injury by ultrasound in a case with H7N9 influenza. Critical Care 2013; 17: 438.
  41. Baldi G., Gargani L., Abramo A. Lung water assessment by lung ultrasonography in intensive care: a pilot study. J Ultrasound Med 2013; 39 (1): 74-84.
  42. Lichtenstein D.А., Goldstein I., Mourgeon E. et al. Comparative Diagnostic Performances of Auscultation, Chest Radiography, and Lung Ultrasonography in Acute Respiratory Distress Syndrome. Anesthesiology 2004; 100: 9-15.
  43. Gargani L. Lung ultrasound: a new tool for the cardiologist. Cardiovasc Ultrasound 2011; 9: 6.
  44. Xirouchaki N., Georgopoulos D. The use of lung ultrasound: A brief review for critical care physicians and pneumonologists. Pneumon 2007; 20: 134-141.
  45. Reissig А., Gramegna A., Aliberti S. The role of lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia. Eur J Intern Med 2012; 23: 391-397.
  46. Mayo P.H., Doelken P. Pleural Ultrasonography. Clin Chest Med 2006; 27: 215-227.
  47. Rahman N.M., Chapman S.J., Davies R.J. Pleural effusion: a structured approach to care. Br Med Bull 2004; 72: 31-47.
  48. Reme´rand F., Dellamonica J., Mao Z., Ferrari F. Multiplane ultrasound approach to quantify pleural effusion at the bedside. Intensive Care Med 2010; 36: 656-664.
  49. Lung D.A. In: Heilmann U. (ed). General ultrasound in the critically ill. Berlin: Springer 2005: 116-128.
  50. Khosla R. Lung Sonography. In: Thoirs K. (ed). Sonography. Rijeka, Croatia: In Tech 2012: 11-130.
  51. Zieleskiewicz L., Lagier D., Contargyris C. et al. Lung ultrasound-guided management of acute breathlessness during pregnancy Anaesthesia 2013; 68: 97-101.
  52. Giannella L., Catania A., Provaroni A. et al. The value of chest ultrasound along with inflammatory biomarkers in the management of pneumonia in a non-compliant pregnant woman. J Maternal-Fetal Neonatal Med 2012; 25 (9): 1830-1832.
  53. Hedrick W.R., Peterson C.L. Image Artifacts in Real-Time Ultrasound. JDMS 1995; 11: 300-308.

Copyright (c) 2015 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

© 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies