Am. J. Respir. Crit. Care Med., Volume 156, Number 5, November 1997, 1640-1646

The Comet-tail Artifact
An Ultrasound Sign of Alveolar-Interstitial Syndrome

DANIEL LICHTENSTEIN, GILBERT MÉZIÈRE, PHILIPPE BIDERMAN, AGNÈS GEPNER, and OLIVIER BARRÉ

Service de Réanimation Médicale and Service de Radiologie, Hôpital Ambroise-Paré, Boulogne (Paris), and Service de Réanimation Polyvalente, Centre Hospitalier Général, Saint-Cloud (Paris), France

Can ultrasound be of any help in the diagnosis of alveolar-interstitial syndrome? In a prospective study, we examined 250 consecutive patients in a medical intensive care unit: 121 patients with radiologic alveolar-interstitial syndrome (disseminated to the whole lung, n = 92; localized, n = 29) and 129 patients without radiologic evidence of alveolar-interstitial syndrome. The antero-lateral chest wall was examined using ultrasound. The ultrasonic feature of multiple comet-tail artifacts fanning out from the lung surface was investigated. This pattern was present all over the lung surface in 86 of 92 patients with diffuse alveolar-interstitial syndrome (sensitivity of 93.4%). It was absent or confined to the last lateral intercostal space in 120 of 129 patients with normal chest X-ray (specificity of 93.0%). Tomodensitometric correlations showed that the thickened sub-pleural interlobular septa, as well as ground-glass areas, two lesions present in acute pulmonary edema, were associated with the presence of the comet-tail artifact. In conclusion, presence of the comet-tail artifact allowed diagnosis of alveolar-interstitial syndrome.

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