Possible Role of Chest Ultrasonography for the Evaluation of Peripheral Fibrotic Pulmonary Changes in Patients Affected by Idiopathic Pulmonary Fibrosis-Pilot Case Series

Future Applications (1) Matching Lung Ultrasonography (LUS) patterns and high-resolution chest CT scan (HRCT) grades of peripheral fibrotic alterations in order to create an "acoustic map". (2) Follow up fibrotic peripheral changes and optimize the timing of subsequent chest CT scans. (3) Differentiate ultrasonographic features in case of GGOs and large honeycomb cysts. (4) Characterization of pleural line in order to better assess specific alteration of peripheral airspace geometry of the lungs resulting in specific acoustic traps. Preliminary data of this work have been presented as a poster to the ERS congress, Madrid 2019.Abstract Lung ultrasonography (LUS) provides an estimation of peripheral airspace (PAS) geometry of the lung. Altered PAS produces sonographic interstitial syndrome (SIS). Idiopathic pulmonary fibrosis (IPF) involves peripheral lung with altered PAS. The aim of the study is to correlate echographic patterns with peripheral fibrotic changes on high-resolution Chest CT scan (HRCT). Patients underwent LUS and HRCT on the same date. Four LUS patterns were described: (1) near normal; (2) SIS with predominance of reverberant artifacts; (3) SIS with vertical predominance; (4) white lung. Four HRCT grades of peripheral fibrotic infiltrates were reported: grade 1 mild; grade 2 moderate; grade 3 severe; grade 4 massive or honeycomb. LUS pattern 1 was indicative of mild to moderate fibrotic alterations in 100% of cases. LUS pattern 2 matched with HRCT grade 2 in 24 out of 30 cases (77%). Huge discordance in four cases because of large honeycomb cysts. LUS pattern 3 was indicative of severe to massive alterations in 100% of cases. LUS pattern 4 showed a heterogeneous distribution of HRCT grades, severe changes, and ground glass opacities (GGO). This preliminary work demonstrates some level of agreement between LUS patterns and HRCT grades. Limitations and methodological issues have been shown to support subsequent studies of agreement.