Research

The 'cardiac-lung mass' artifact: an echocardiographic sign of lung atelectasis and/or pleural effusion

Andreas Karabinis¹ , Theodosios Saranteas¹ , Dimitrios Karakitsos¹ , Daniel Lichtenstein² , John Poularas¹ , Clifford Yang³ and Christodoulos Stefanadis⁴

¹  Department of Intensive Care Medicine, General Hospital of Athens, Mesogeion Avenue, Athens, 115 27, Greece

²  Ambroise-Paré Hospital, Faculté Paris-Ouest, Paris, Boulogne, F-92100, France

³  Department of Diagnostic Imaging and Therapeutics, University of Connecticut Health Center, Farmington, CT 06030, USA

⁴  1st Cardiology Department, Athens University Medical School, Hippokration Hospital, V. Sofias, Athens, 115 27, Greece

author email corresponding author email

Critical Care 2008, 12:R122doi:10.1186/cc7021

Published:	30 September 2008

Abstract

Introduction

We conducted an ultrasound study to investigate echocardiographic artifacts in mechanically ventilated patients with lung pathology.

Methods

A total of 205 mechanically ventilated patients who exhibited lung atelectasis and/or pleural effusion were included in this 36-month study. The patients underwent lung echography and transthoracic echocardiography, with a linear 5 to 10 MHz and with a 1.5 to 3.6 MHz wide-angle phased-array transducer, respectively. Patients were examined by two experienced observers who were blinded to each other's interpretation.

Results

A total of 124 patients (60,48%) were hospitalized because of multiple trauma; 60 patients (29,26%) because of respiratory insufficiency, and 21 (10,24%) because of recent postoperative surgery. The mean duration ( ± standard deviation) of hospitalization was 35 ± 27 days. An intracardiac artifact was documented in 17 out of 205 patients (8.29%) by echocardiography. It was visible only in the apical views, whereas subsequent transesophageal echocardiography revealed no abnormalities. The artifact consisted of a mobile component that exhibited, on M-mode, a pattern of respiratory variation similar to the lung 'sinusoid sign'. Lung echography revealed lung atelectasis and/or pleural effusion adjacent to the heart, and a similar M-mode pattern was observed. The artifact was recorded within the left cardiac chambers in 11 cases and within the right cardiac chambers in six.

Conclusions

Lung atelectasis and/or pleural effusion may create a mirror image, intracardiac artifact in mechanically ventilated patients. The latter was named the 'cardiac-lung mass' artifact to underline the important diagnostic role of both echocardiography and lung echography in these patients.

Trial registration

This trial is ISRCTN registered: ISRCTN 49216096.