From an abdominal ultrasound to a lung disease passing through the diaphragm: a case of idiopathic pulmonary fibrosis
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CASE REPORT
From an abdominal ultrasound to a lung disease passing through the diaphragm: a case of idiopathic pulmonary fibrosis Andrea Boccatonda1 · Imperia Liberatore1 · Giulio Cocco1 · Damiano D’Ardes1 · Stefano Marinari2 · Cosima Schiavone1 Received: 13 December 2019 / Accepted: 23 February 2020 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2020
Abstract Rationale Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterized by abnormal and excessive deposition of collagen in the pulmonary interstitium (fibrosis) with minimal associated inflammation evolving into progressive and irreversible decline in lung function. Patient concerns Patient referred discomfort, bilateral upper quadrant abdominal pain, and progressive exertional dyspnea (shortness of breath with exercise). Diagnosis Exertional dyspnea due to idiopathic pulmonary fibrosis (IPF). Intervention Sonographic evaluation demonstrated an alteration of diaphragm excursion together with a relevant alteration of the pleural line and multiple irregular and confluent B lines. Conclusions Lung and diaphragm ultrasound could be employed as a screening or first-line diagnostic tool in the suspicion of interstitial lung disease. Keywords Ultrasound · Lung · Fibrosis · Idiopathic pulmonary fibrosis · Diaphragm
Introduction The diaphragm contributes to 75% of the pulmonary ventilation and has been extensively examined by several approaches that are often invasive and sometimes dangerous for the patient [1, 2]. Therefore, many studies tried to standardize an ultrasound evaluation of the diaphragm excursion in case of respiratory diseases such as acute respiratory failure and chronic lung syndromes (e.g., chronic obstructive pulmonary disease) [3–6]. Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterized by abnormal and excessive deposition of collagen in the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40477-020-00445-y) contains supplementary material, which is available to authorized users. * Andrea Boccatonda [email protected] 1
Internistic Ultrasound Unit, SS Annunziata Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy
Pneumology, SS Annunziata Hospital, “G. d’Annunzio” University, Chieti, Italy
2
pulmonary interstitium (fibrosis) with minimal associated inflammation evolving into progressive and irreversible decline in lung function [7]. Here, we report the case of a 68-year-old man referred to our unit complaining exertional dyspnea and bilateral upper quadrant abdominal pain, with pulmonary and diaphragmatic ultrasound findings suggestive for IPF.
Case report A 68-year-old caucasian patient came to our internal medicine ultrasound unit to perform a sonographic abdominal examination as prescribed by general practitioner. He referred discomfort and bilateral upper quadrant abdominal pain and progressive exertional dyspnea (shortness of breath with exercise). His past medical history was characterized by high bl
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