Lung ultrasound for organ donation and transplantation

Abstract

Lung ultrasound (LUS) has emerged as a valuable, non-invasive imaging modality that enhances bedside clinical assessment without exposing patients to ionising radiation. Despite its current widespread use, LUS was historically met with considerable scepticism, with many clinicians sharing the view expressed in authoritative texts such as Harrison’s Principles of Internal Medicine, which noted the thorax was unsuitable for Ultrasound (US) evaluation due to the air-filled lungs acting as a barrier for US (Fauci et al., 1997). This sentiment was encapsulated by Daniel Lichtenstein, who reflected on the prevailing attitudes of the 1990s with the phrase: “Ultrasound, not us. Lung ultrasound, impossible” (Lichtenstein, 2016, pp. 265).

Nevertheless, work by innovators such as Dr. Jos Roelandt, a Dutch cardiologist, demonstrated the potential of thoracic ultrasound as early as 1978 (Roelandt et al., 1978) His pioneering efforts influenced subsequent generations of clinicians, including Lichtenstein, who in 1993 published one of the earliest studies applying LUS within the Intensive Care Unit (ICU). Here, D. Lichtenstein & Axler (1993) demonstrated the effectiveness of LUS in confirming diagnoses and altering treatment plans in patients. These early findings directly challenged longstanding assumptions about the limitations of US in thoracic imaging. Today, the diagnostic relevance of LUS in a variety of clinical contexts continues to affirm the validity of those initial insights.