{"id":24985,"date":"2025-02-21T11:59:16","date_gmt":"2025-02-21T11:59:16","guid":{"rendered":"https:\/\/takayama-site.com\/echographie\/?p=24985"},"modified":"2025-02-21T13:33:52","modified_gmt":"2025-02-21T13:33:52","slug":"un-bond-en-avant-dans-la-detection-de-la-surcharge-pulmonaire","status":"publish","type":"post","link":"https:\/\/takayama-site.com\/echographie\/un-bond-en-avant-dans-la-detection-de-la-surcharge-pulmonaire\/","title":{"rendered":"Un bond en avant dans la d\u00e9tection de la surcharge pulmonaire"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"24985\" class=\"elementor elementor-24985\">\n\t\t\t\t<div class=\"elementor-element elementor-element-31634374 e-flex e-con-boxed e-con e-parent\" data-id=\"31634374\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e26356e elementor-widget-mobile__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"e26356e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">Deux si\u00e8cles apr\u00e8s l&rsquo;invention du st\u00e9thoscope par Ren\u00e9 La\u00ebnnec, l&rsquo;examen clinique traditionnel reste limit\u00e9 pour \u00e9valuer la congestion et la surcharge liquidienne, malgr\u00e9 les avanc\u00e9es m\u00e9dicales. En effet, les outils cliniques classiques pr\u00e9sentent une sensibilit\u00e9 et une sp\u00e9cificit\u00e9 modestes pour la d\u00e9tection de l&rsquo;insuffisance cardiaque, comme illustr\u00e9 ci-dessous :<\/p><p style=\"text-align: justify;\"><span style=\"color: #000000; font-size: 12pt;\"><strong>Performance diagnostique des signes cliniques classiques de l&rsquo;insuffisance cardiaque<\/strong><\/span><\/p><p><span style=\"font-size: 8pt;\"><em>(Adapt\u00e9 de Dao Q et al. JACC Vol. 37, No. 2, 2001)<\/em><\/span><\/p><table style=\"height: 205px; width: 100.996%; border-collapse: collapse; border-style: none; border-color: #ffffff;\"><tbody><tr style=\"border-style: solid; background-color: #f768e7;\"><td style=\"width: 27.9131%; border-color: #000000; height: 24px; border-style: none;\"><span style=\"color: #ffffff;\"><strong>Signe clinique<\/strong><\/span><\/td><td style=\"width: 24.637%; border-color: #000000; height: 24px; border-style: none; text-align: center;\"><span style=\"color: #ffffff;\"><strong>Sensibilit\u00e9 (%)<\/strong><\/span><\/td><td style=\"width: 21.3627%; border-color: #000000; height: 24px; border-style: none; text-align: center;\"><span style=\"color: #ffffff;\"><strong>Sp\u00e9cificit\u00e9 (%)<\/strong><\/span><\/td><td style=\"width: 17.2608%; border-color: #000000; height: 24px; border-style: none; text-align: center;\"><span style=\"color: #ffffff;\"><strong>Pr\u00e9cision (%)<\/strong><\/span><\/td><\/tr><tr style=\"border-color: #ffffff; border-style: none;\"><td style=\"width: 27.9131%; height: 24px; border-color: #000000; border-style: none;\" width=\"216\">Orthopn\u00e9e<\/td><td style=\"width: 24.637%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">47<\/td><td style=\"width: 21.3627%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">88<\/td><td style=\"width: 17.2608%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">72<\/td><\/tr><tr style=\"border-color: #ffffff; border-style: none;\"><td style=\"width: 27.9131%; height: 24px; border-color: #000000; border-style: none;\">Dilatation des veines jugulaires<\/td><td style=\"width: 24.637%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">39<\/td><td style=\"width: 21.3627%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">94<\/td><td style=\"width: 17.2608%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">72<\/td><\/tr><tr style=\"border-color: #ffffff; border-style: none;\"><td style=\"width: 27.9131%; height: 24px; border-color: #000000; border-style: none;\">\u0152d\u00e8mes<\/td><td style=\"width: 24.637%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">67<\/td><td style=\"width: 21.3627%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">68<\/td><td style=\"width: 17.2608%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">68<\/td><\/tr><tr style=\"border-color: #ffffff; border-style: none;\"><td style=\"width: 27.9131%; height: 24px; border-color: #000000; border-style: none;\">R\u00e2les cr\u00e9pitants<\/td><td style=\"width: 24.637%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">56<\/td><td style=\"width: 21.3627%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">80<\/td><td style=\"width: 17.2608%; height: 24px; border-color: #000000; border-style: none; text-align: center;\">70<\/td><\/tr><\/tbody><\/table><p><strong style=\"font-size: 12pt; color: #ff00ff;\">L&rsquo;apport de l&rsquo;\u00e9chographie pulmonaire au point d\u2019intervention<\/strong><\/p><p style=\"text-align: justify;\">L&rsquo;\u00e9chographie pulmonaire se r\u00e9v\u00e8le nettement plus performante pour d\u00e9tecter la congestion pulmonaire. Elle affiche une sensibilit\u00e9 de 97 % et une sp\u00e9cificit\u00e9 de 98 %, surpassant ainsi :<\/p><ul style=\"text-align: justify;\"><li style=\"text-align: left;\">L&rsquo;examen clinique traditionnel (sensibilit\u00e9 : 64 %, sp\u00e9cificit\u00e9 : 67 %)<\/li><li style=\"text-align: left;\">La radiographie thoracique (sensibilit\u00e9 : 63 %, sp\u00e9cificit\u00e9 : 93 %)<\/li><\/ul><p style=\"text-align: justify;\">En cas de surcharge pulmonaire, l&rsquo;\u00e9chographie met en \u00e9vidence les lignes B, artefacts verticaux hyper\u00e9chog\u00e8nes \u00e9manant de la ligne pleurale et traversant l&rsquo;\u00e9cran sans att\u00e9nuation. Le Pr D.\u00a0 Lichtenstein, pionnier de l&rsquo;\u00e9chographie pulmonaire, a \u00e9t\u00e9 le premier \u00e0 d\u00e9crire, en 1997, les lignes B comme la traduction \u00e9chographique du syndrome alv\u00e9olo-interstitiel.<\/p><p>Ces lignes B se synchronisent avec le glissement pleural et effacent les lignes A. Leur pr\u00e9sence traduit un contact entre les pl\u00e8vres pari\u00e9tale et visc\u00e9rale.<img fetchpriority=\"high\" decoding=\"async\" class=\"wp-image-24986 size-full aligncenter\" src=\"https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/Picture1-e1740144036561.jpg\" alt=\"\" width=\"285\" height=\"312\" srcset=\"https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/Picture1-e1740144036561.jpg 285w, https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/Picture1-e1740144036561-274x300.jpg 274w\" sizes=\"(max-width: 285px) 100vw, 285px\" \/><span style=\"font-size: 12pt;\"><strong>Protocole des huit zones thoraciques<\/strong><\/span><\/p><p style=\"text-align: justify;\">Pour diagnostiquer un \u0153d\u00e8me pulmonaire ou un syndrome interstitiel, on utilise un protocole d&rsquo;examen thoracique en 8 zones. L&rsquo;examen est consid\u00e9r\u00e9 positif si au moins deux zones bilat\u00e9rales pr\u00e9sentent trois lignes B visibles en coupe longitudinale entre deux c\u00f4tes.<img decoding=\"async\" class=\"aligncenter wp-image-24987\" style=\"font-size: 16px;\" src=\"https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/Picture2.png\" alt=\"\" width=\"300\" height=\"261\" \/><span style=\"font-size: 12pt; color: #ff00ff;\"><strong>Interpr\u00e9tation et li<\/strong><\/span><strong style=\"color: #ff00ff; font-size: 12pt;\">mites de l&rsquo;ex<\/strong><strong style=\"color: #ff00ff; font-size: 12pt;\">amen<\/strong><\/p><p style=\"text-align: justify;\">Il est essentiel de noter que la pr\u00e9sence de lignes B n&rsquo;est pas sp\u00e9cifique \u00e0 l&rsquo;\u0153d\u00e8me pulmonaire. Elles peuvent \u00eatre observ\u00e9es dans diverses pathologies telles que :<\/p><ul style=\"list-style-type: disc; text-align: justify;\"><li>Pneumonie<\/li><li>At\u00e9lectasie<\/li><li>Contusion pulmonaire<\/li><\/ul><p style=\"text-align: justify;\">L&rsquo;interpr\u00e9tation de l&rsquo;\u00e9chographie pulmonaire doit donc toujours se faire dans le contexte clinique global. Par exemple :<\/p><p style=\"text-align: justify;\">Si un patient pr\u00e9sente une dyspn\u00e9e, une orthopn\u00e9e, des \u0153d\u00e8mes, une hypertension et des lignes B dans plusieurs zones pulmonaires, un \u0153d\u00e8me pulmonaire cardiog\u00e9nique est fortement probable.<\/p><p style=\"text-align: justify;\">Si un patient pr\u00e9sente une dyspn\u00e9e, de la fi\u00e8vre, de la toux et des lignes B localis\u00e9es avec une ligne pleurale irr\u00e9guli\u00e8re, une pneumonie doit \u00eatre envisag\u00e9e.<\/p><p style=\"text-align: justify;\"><span style=\"font-size: 12pt; color: #ff00ff;\"><strong>Conclusion<\/strong><\/span><\/p><p style=\"text-align: justify;\">L&rsquo;\u00e9chographie pulmonaire au point d\u2019intervention constitue un progr\u00e8s majeur dans l&rsquo;\u00e9valuation de la surcharge pulmonaire. Son adoption croissante par les cliniciens devrait permettre une meilleure strat\u00e9gie de prise en charge des patients atteints d&rsquo;insuffisance cardiaque ou d&rsquo;autres pathologies pulmonaires.<\/p><hr \/><p style=\"text-align: justify;\"><span style=\"font-size: 12pt; color: #000000;\"><strong>Sources<\/strong><\/span><\/p><ul><li style=\"text-align: justify;\">Reisinger N, Koratala A. <em>Quantitative lung ultrasonography for the nephrologist: applications in dialysis and heart failure.<\/em> Kidney360 2021;3:176\u201384.<\/li><li style=\"text-align: justify;\">Koratala A, Kazory A. <em>An introduction to point-of-care ultrasound: Laennec to Lichtenstein.<\/em> Adv Chronic Kidney Dis 2021;28:193\u20139.<\/li><li style=\"text-align: justify;\">Arts L et al. <em>The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis.<\/em> Sci Rep 2020;10:7347.<\/li><li style=\"text-align: justify;\">Maw AM, Hassanin A et al. <em>Diagnostic accuracy of point-of-care lung ultrasonography and chest radiography in adults with symptoms suggestive of acute decompensated heart failure: a systematic review and meta-analysis.<\/em> JAMA Netw Open. 2019;2:e190703.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Deux si\u00e8cles apr\u00e8s l&rsquo;invention du st\u00e9thoscope par Ren\u00e9 La\u00ebnnec, l&rsquo;examen clinique traditionnel reste limit\u00e9 pour \u00e9valuer la congestion et la surcharge liquidienne, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":25005,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[117],"tags":[],"class_list":["post-24985","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news"],"rttpg_featured_image_url":{"full":["https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/surchage-pulmonaire-free-pik.png",896,1152,false],"landscape":["https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/surchage-pulmonaire-free-pik.png",896,1152,false],"portraits":["https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/surchage-pulmonaire-free-pik.png",896,1152,false],"thumbnail":["https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/surchage-pulmonaire-free-pik-150x150.png",150,150,true],"medium":["https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/surchage-pulmonaire-free-pik-233x300.png",233,300,true],"large":["https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/surchage-pulmonaire-free-pik-796x1024.png",796,1024,true],"1536x1536":["https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/surchage-pulmonaire-free-pik.png",896,1152,false],"2048x2048":["https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/surchage-pulmonaire-free-pik.png",896,1152,false],"uicore-medium":["https:\/\/takayama-site.com\/echographie\/wp-content\/uploads\/2025\/02\/surchage-pulmonaire-free-pik-506x650.png",506,650,true]},"rttpg_author":{"display_name":"takayama","author_link":"https:\/\/takayama-site.com\/echographie\/author\/takayama\/"},"rttpg_comment":0,"rttpg_category":"<a href=\"https:\/\/takayama-site.com\/echographie\/category\/news\/\" rel=\"category tag\">News<\/a>","rttpg_excerpt":"Deux si\u00e8cles apr\u00e8s l&rsquo;invention du st\u00e9thoscope par Ren\u00e9 La\u00ebnnec, l&rsquo;examen clinique traditionnel reste limit\u00e9 pour \u00e9valuer la congestion et la surcharge liquidienne, [&hellip;]","_links":{"self":[{"href":"https:\/\/takayama-site.com\/echographie\/wp-json\/wp\/v2\/posts\/24985","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/takayama-site.com\/echographie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/takayama-site.com\/echographie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/takayama-site.com\/echographie\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/takayama-site.com\/echographie\/wp-json\/wp\/v2\/comments?post=24985"}],"version-history":[{"count":33,"href":"https:\/\/takayama-site.com\/echographie\/wp-json\/wp\/v2\/posts\/24985\/revisions"}],"predecessor-version":[{"id":25032,"href":"https:\/\/takayama-site.com\/echographie\/wp-json\/wp\/v2\/posts\/24985\/revisions\/25032"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/takayama-site.com\/echographie\/wp-json\/wp\/v2\/media\/25005"}],"wp:attachment":[{"href":"https:\/\/takayama-site.com\/echographie\/wp-json\/wp\/v2\/media?parent=24985"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/takayama-site.com\/echographie\/wp-json\/wp\/v2\/categories?post=24985"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/takayama-site.com\/echographie\/wp-json\/wp\/v2\/tags?post=24985"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}