Advances in technology have greatly improved the imaging capabilities of ultrasound (US). This article summarizes the current applications of US as a diagnostic tool in chest diseases. By scanning through the acoustic window, US is a very reliable and efficient tool for evaluating lesions of the chest wall, pleural cavity, peridiaphragm, mediastinum, hilum, and peripheral lungs. A precise puncture transducer can be used to perform US-guided transthoracic needle biopsy (TNB) with real-time visualization of the biopsy needle and the lesion. The accuracy of US-guided TNB for peripheral pulmonary nodules, chest wall lesions, and mediastinal tumors is 88% to 100%. US-guided TNB is also useful for histologic diagnosis of tumors causing superior vena cava (SVC) syndrome, Pancoast's tumors, pulmonary consolidation of unknown etiology, and tumors with obstructive pneumonitis. Moreover, transthoracic needle aspiration under US guidance can provide adequate specimens for microbiologic diagnosis of lung abscesses, necrotizing pneumonia, and parapneumonic effusions. Color Doppler imaging further extends the diagnostic spectrum of US, allowing the hemodynamics and neovascularization of a pulmonary lesion to be assessed noninvasively. Pulmonary arteriovenous malformations, pulmonary sequestration, and pulmonary infarctions can be diagnosed easily with color Doppler US. The color Doppler US puncture guiding device can improve the safety of US-guided TNB by simultaneously displaying blood vessel information, the needle shaft, and the puncture route. US examination and US-guided TNB have become indispensable diagnostic techniques for various chest diseases.

TNB with imaging guidance is a well-established technique for the diagnosis of focal pulmonary lesions.<sup>6Klein J.S., Zarka M.A. Transthoracic needle biopsy: An overview J Thorac Imaging 1997 ;  12 : 232-249 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 22Westcott J.L. Percutaneous transthoracic needle biopsy Radiology 1988 ;  169 : 593-601

Cliccare qui per andare alla sezione Riferimenti</sup> CT and biplane fluoroscopy are the most common imaging modalities used to guide TNB. With advances in imaging capabilities, biopsy techniques, and cytopathology, CT- and fluoroscopy-guided TNB can now provide extremely high diagnostic yields (sensitivity 80% to 95%) and are relatively safe.<sup>6Klein J.S., Zarka M.A. Transthoracic needle biopsy: An overview J Thorac Imaging 1997 ;  12 : 232-249 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 21Westcott J. Direct percutaneous needle aspiration of localized pulmonary lesions: Results in 422 patients Radiology 1980 ;  137 : 31-35

Cliccare qui per andare alla sezione Riferimenti</sup> These diagnostic modalities may be time-consuming, however, especially for small peripheral pulmonary lesions, and carry the risk of excessive exposure to radiation.

Recently, rapid advances in transducer design, signal processing, and Doppler technology have greatly improved the imaging quality of US. With the development of a precise puncture-guiding device, US has proved to be a reliable, efficient, and informative imaging modality for evaluation of a wide variety of complicated clinical problems associated with chest diseases.<sup>12Mathis G. Thorax sonography—part II: Peripheral pulmonary consolidation Ultrasound Med Biol 1997 ;  23 : 1141-1153 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 26Yang P.C. Applications of colour Doppler ultrasound in the diagnosis of chest diseases Respirology 1997 ;  2 : 231-238 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 32Yang P.C., Kuo S.H., Luh K.T. Ultrasonography and ultrasound guided needle biopsy of chest diseases: Indications, techniques, diagnostic yields and complications J Med Ultrasound 1993 ;  2 : 53-63

Cliccare qui per andare alla sezione Riferimenti, 33Yang P.C., Lee L.N., Luh K.T., e al. Ultrasonography of Pancoast tumor Chest 1988 ;  94 : 124-128 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 35Yang P.C., Luh K.T., Chang D.B., e al. Ultrasonographic evaluation of pulmonary consolidation Am Rev Respir Dis 1992 ;  146 : 757-762

Cliccare qui per andare alla sezione Riferimenti, 36Yang P.C., Luh K.T., Chang D.B., e al. Value of sonography to determine the nature of pleural effusion: Analysis of 320 cases AJR Am J Roentgenol 1992 ;  159 : 29-33

Cliccare qui per andare alla sezione Riferimenti, 37Yang P.C., Luh K.T., Lee Y.C., e al. Lung abscesses— Ultrasonography and ultrasound-guided transthoracic aspiration Radiology 1991 ;  180 : 171-175

Cliccare qui per andare alla sezione Riferimenti, 38Yang P.C., Luh K.T., Sheu J.C., e al. Peripheral pulmonary lesions: Ultrasonography and ultrasonically guided aspiration biopsy Radiology 1985 ;  155 : 451-456

Cliccare qui per andare alla sezione Riferimenti, 39Yang P.C., Luh K.T., Wu H.D., e al. Lung tumors associated with obstructive pneumonitis: US studies Radiology 1990 ;  174 : 717-720

Cliccare qui per andare alla sezione Riferimenti, 40Yang P.C., Sheu J.C., Luh K.T., e al. Clinical application of real time ultrasonography in pleural and subpleural lesion J Formos Med Assoc 1984 ;  83 : 646-657

Cliccare qui per andare alla sezione Riferimenti, 41Yu C.J., Yang P.C., Chang D.B., e al. Diagnostic and therapeutic use of chest sonography: Value in critically ill patients AJR Am J Roentgenol 1992 ;  159 : 695-701

Cliccare qui per andare alla sezione Riferimenti, 43Yu C.J., Yang P.C., Chang D.B., e al. Ultrasound study in unilateral hemothorax opacification: Image comparison with computed tomography Am Rev Respir Dis 1993 ;  147 : 430-434

Cliccare qui per andare alla sezione Riferimenti</sup> It can also be used effectively to guide TNB and other interventional procedures in the thorax.<sup>1Chang D.B., Yang P.C., Luh K.T., e al. Ultrasound-guided pleural biopsy with Tru-cut needle Chest 1991 ;  100 : 1328-1333 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 2Chang D.B., Yang P.C., Yu C.J., e al. Ultrasonography and ultrasonographically guided fine needle biopsy of impalpable cervical lymphnodes in patients with non-small cell lung cancer Cancer 1992 ;  70 : 1111-1114 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 5Izumi S., Tamaki S., Natori H., e al. Ultrasonically guided aspiration needle biopsy in disease of chest Am Rev Respir Dis 1982 ;  125 : 460-464

Cliccare qui per andare alla sezione Riferimenti, 8Ko J.C., Yang P.C., Yuan A., e al. Superior vena cava syndrome: Rapid histologic diagnosis by ultrasound-guided transthoracic needle aspiration biopsy Am J Respir Crit Care Med 1994 ;  93 : 250-252

Cliccare qui per andare alla sezione Riferimenti, 13Pan J.F., Yang P.C., Chang D.B., e al. Needle aspiration biopsy of malignant lung masses with necrotic centers: Improved sensitivity with ultrasonic guidance Chest 1993 ;  103 : 1452-1456 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 19Wang H.C., Yang P.C., Yu C.J., e al. Transthoracic needle biopsy of thoracic tumor by color Doppler ultrasound puncture guiding device Thorax 1995 ;  50 : 1258-1263 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 28Yang P.C. Ultrasound-guided transthoracic biopsy of peripheral lung, pleural, and chest wall lesions J Thorac Imaging 1997 ;  12 : 272-284 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 29Yang P.C., Chang D.B., Lee Y.C., e al. Mediastinal malignancy: Ultrasound guided biopsy through supraclavicular approach Thorax 1992 ;  47 : 377-380 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 30Yang P.C., Chang D.B., Yu C.J., e al. Ultrasound-guided percutaneous cutting biopsy for the diagnosis of pulmonary consolidations of unknown etiology Thorax 1992 ;  47 : 457-460 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 31Yang P.C., Chang D.B., Yu C.J., e al. Ultrasound-guided core biopsy of thoracic tumors Am Rev Respir Dis 1992 ;  146 : 763-767

Cliccare qui per andare alla sezione Riferimenti, 34Yang P.C., Lee Y.C., Yu C.J., e al. Ultrasonographically guided biopsy of thoracic tumors: A comparison of large-bore cutting biopsy with fine-needle aspiration Cancer 1992 ;  69 : 2553-2560 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> This article presents an overview of the state-of-art applications of US-guided transthoracic biopsy in chest diseases including indications and contraindications, imaging techniques, biopsy procedures, diagnostic spectrum and sensitivity, potential complications, and advantages and limitations.