亀田 徹¹, 小林 英夫², 山田 博胤³, 谷口 信行⁴

Toru KAMEDA¹, Hideo KOBAYASHI², Hirotsugu YAMADA³, Nobuyuki TANIGUCHI⁴

¹安曇野赤十字病院救急科, ²防衛医科大学校内科学2, ³徳島大学病院循環器内科, ⁴自治医科大学臨床検査医学

¹Department of Emergency Medicine, Red Cross Society Azumino Hospital, ²Second Department of Internal Medicine, National Defense Medical College, ³Department of Cardiovascular Medicine, Tokushima University Hospital, ⁴Department of Clinical Laboratory Medicine, Jichi Medical University

キーワード : acute decompensated heart failure, point-of-care ultrasound, lung ultrasound, ring-down artifact, sonographic interstitial syndrome

Point-of-care超音波では，胸膜ラインから深部に向かって減衰することなく伸びる線状のアーチファクトは「Bライン」と呼称され，肺水腫や炎症性疾患で顕在化する．近年Bラインを用いた肺超音波の診断能について検討した前向き臨床研究が数多く報告され，Bラインは心原性肺水腫の診断に役立つことが明らかになった．肺超音波は，病院前救急や救急室における心原性肺水腫の迅速な診断，集中治療室や一般病棟におけるモニタリングとして利用が期待されている．その普及にあたり，肺超音波用のプリセットの導入や，Bラインの定量化についての検討が必要であり，他の画像診断との使い分けも考慮すべきである．さらにBラインを用いた超音波診断が患者ケアの向上に寄与するかについて質の高い大規模臨床研究が求められる．

In point-of-care ultrasound, the artifacts that arise from the pleural line and extend to the bottom of the screen without fading are now known as ‘B-lines’, which are evident in patients with pulmonary edema and inflammatory diseases. Many recent prospective studies on the diagnostic performance of lung ultrasound with B-lines have been published, and it has become evident that the presence of B-lines is useful for the diagnosis of cardiogenic pulmonary edema. Lung ultrasound is promising as a modality for the rapid diagnosis of cardiogenic pulmonary edema in prehospital settings and the emergency room, and for monitoring in intensive care units and general wards. As the use of lung ultrasound at the bedside becomes widespread, preset features of the lung will be needed for each ultrasound machine, and research on quantification of B-lines will be necessary. The appropriate selection of lung imaging modalities should also be considered. Furthermore, large clinical trials are needed to investigate whether or not lung ultrasound for the diagnosis of pulmonary edema improves patient care.