{"id":152930,"date":"2020-03-16T16:27:37","date_gmt":"2020-03-16T23:27:37","guid":{"rendered":"https:\/\/clarius.com\/blog\/utilite-clinique-et-technique-de-lechographie-pulmonaire-dans-les-cas-covid-19\/"},"modified":"2026-09-06T08:19:32","modified_gmt":"2026-09-06T15:19:32","slug":"utilite-clinique-et-technique-de-lechographie-pulmonaire-dans-les-cas-covid-19","status":"publish","type":"post","link":"https:\/\/clarius.com\/fr\/blog\/utilite-clinique-et-technique-de-lechographie-pulmonaire-dans-les-cas-covid-19\/","title":{"rendered":"Utilit\u00e9 clinique et technique de l&rsquo;\u00e9chographie pulmonaire dans les cas COVID-19"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Daniel J. Kim, MD FRCPC<\/p>\n\n<table><tr><td width=\"40%\" style=\"padding:30px\"><figure class=\"wp-block-image size-large is-resized is-style-circle-mask\"><img decoding=\"async\" data-src=\"https:\/\/clarius.com\/wp-content\/uploads\/2020\/03\/DanKim.jpeg\" alt=\"\" class=\"wp-image-9875 lazyload\" width=\"200\" height=\"200\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 200px; --smush-placeholder-aspect-ratio: 200\/200;\" \/><\/figure><\/td><td><i>Le Dr Kim est m\u00e9decin urgentiste \u00e0 Vancouver. Pour aider les utilisateurs de Clarius \u00e0 comprendre comment ils peuvent utiliser l&rsquo;\u00e9chographie dans le d\u00e9pistage et le suivi de COVID-19, nous avons demand\u00e9 au Dr Kim de r\u00e9diger un article r\u00e9sumant les meilleures pratiques actuelles. Clarius partagera des mises \u00e0 jour sur l&rsquo;utilisation de l&rsquo;\u00e9chographie pour le COVID-19 au fur et \u00e0 mesure que de nouvelles informations et ressources seront disponibles.  <\/i><\/td><\/tr><\/table>\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n<p class=\"wp-block-paragraph\">Depuis l&rsquo;apparition d&rsquo;un nouveau coronavirus \u00e0 Wuhan en d\u00e9cembre 2019 et\nson \u00e9volution ult\u00e9rieure vers une pand\u00e9mie en mars 2020, l&rsquo;utilit\u00e9 de l&rsquo;\u00e9chographie pulmonaire dans le bilan et la prise en charge du COVID-19 suscite un int\u00e9r\u00eat croissant\n.<\/p>\n\n<p class=\"wp-block-paragraph\"><strong>D\u00e9pistage<\/strong><\/p>\n\n<p class=\"wp-block-paragraph\">\u00c9tant donn\u00e9 que les r\u00e9sultats de l&rsquo;imagerie ne sont pas sp\u00e9cifiques, l&rsquo;\u00e9chographie pulmonaire n&rsquo;a pas sa place chez un patient cliniquement bien portant\npr\u00e9sentant des sympt\u00f4mes b\u00e9nins. Ces patients\ndoivent \u00eatre test\u00e9s \u00e0 l&rsquo;aide d&rsquo;\u00e9couvillons nasopharyng\u00e9s pour la RT-PCR conform\u00e9ment aux directives locales de sant\u00e9 publique\n. <\/p>\n\n<p class=\"wp-block-paragraph\">Des cas de patients pr\u00e9sentant des r\u00e9sultats typiques de COVID-19 au scanner thoracique\nont \u00e9t\u00e9 rapport\u00e9s, alors que les r\u00e9sultats de la RT-PCR \u00e9taient initialement n\u00e9gatifs. Ces 5 patients\nont finalement obtenu des r\u00e9sultats RT-PCR positifs apr\u00e8s des tests r\u00e9p\u00e9t\u00e9s. L&rsquo;\u00e9chographie pulmonaire\npeut \u00eatre utile pour les patients ayant une forte suspicion clinique de\nCOVID-19 mais un d\u00e9pistage RT-PCR n\u00e9gatif s&rsquo;ils pr\u00e9sentent des r\u00e9sultats \u00e9chographiques pulmonaires\ntypiques de COVID-19.    &lt;1&gt;<\/p>\n\n<p class=\"wp-block-paragraph\"><strong>Technique<\/strong><\/p>\n\n<p class=\"wp-block-paragraph\">2 petites \u00e9tudes d\u00e9crivant les r\u00e9sultats de l&rsquo;\u00e9chographie pulmonaire COVID-19 ont utilis\u00e9 une approche\ncibl\u00e9e sur 12 zones. &lt;2,3&gt; Chaque poumon a \u00e9t\u00e9 divis\u00e9 par la ligne\naxillaire ant\u00e9rieure et la ligne axillaire post\u00e9rieure en 3 zones : ant\u00e9rieure, lat\u00e9rale et\npost\u00e9rieure. Chacune de ces zones a ensuite \u00e9t\u00e9 divis\u00e9e en un champ\nsup\u00e9rieur et inf\u00e9rieur, de sorte que chaque poumon a \u00e9t\u00e9 divis\u00e9 en 6 zones. Pour maximiser la sensibilit\u00e9, la plus grande partie possible du champ pulmonaire\ndoit \u00eatre visualis\u00e9e.  <\/p>\n\n<p class=\"wp-block-paragraph\">L&rsquo;utilisation d&rsquo;une sonde lin\u00e9aire est pr\u00e9f\u00e9rable pour identifier les anomalies pleurales et\nsous-pleurales. Une sonde curviligne ou \u00e0 r\u00e9seau phas\u00e9 est plus efficace pour\nmettre en \u00e9vidence les lignes B. Le scanner pulmonaire doit \u00eatre effectu\u00e9 perpendiculairement \u00e0\nle contour de la ligne pleurale.  <\/p>\n\n<p class=\"wp-block-paragraph\"><strong>Diagnostic<\/strong><\/p>\n\n<p class=\"wp-block-paragraph\">2 petites \u00e9tudes incluant 20 patients chacune d\u00e9crivent les r\u00e9sultats suivants de l&rsquo;\u00e9chographie du poumon\ndans COVID-19 :  &lt;2,3&gt;<\/p>\n\n<h2 class=\"wp-block-heading\">Lignes B d&rsquo;aspect variable, notamment focales, multifocales et confluentes<\/h2>\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img decoding=\"async\" src=\"https:\/\/clarius.com\/wp-content\/uploads\/2020\/03\/1-blines.gif\" alt=\"\" class=\"wp-image-9870\" \/><figcaption>  @giovlpicelli : <em><a href=\"https:\/\/twitter.com\/giovolpicelli\/status\/1238470459680870401\">https:\/\/twitter.com\/giovolpicelli\/status\/1238470459680870401<\/a><\/em><\/figcaption><\/figure><\/div>\n\n<h2 class=\"wp-block-heading\">Consolidations sous-pleurales  <\/h2>\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img decoding=\"async\" src=\"https:\/\/clarius.com\/wp-content\/uploads\/2020\/03\/2-sub-pleural-consolidation.gif\" alt=\"\" class=\"wp-image-9871\" \/><figcaption>@drmarcogarrone : <em>https:\/\/twitter.com\/drmarcogarrone\/status\/1236256917800050688<\/em><\/figcaption><\/figure><\/div>\n\n<h2 class=\"wp-block-heading\">Consolidations plus importantes avec bronchogrammes a\u00e9riens occasionnels<\/h2>\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large is-resized\"><img decoding=\"async\" src=\"https:\/\/clarius.com\/wp-content\/uploads\/2020\/03\/3-large-consolidation.gif\" alt=\"\" class=\"wp-image-9872\" width=\"580\" height=\"386\" \/><figcaption>@PARADicmSHIFT <a style=\"font-style: italic\" href=\"https:\/\/twitter.com\/PARADicmSHIFT\/status\/1238357156463869953\">: https:\/\/twitter.com\/PARADicmSHIFT\/status\/1238357156463869953<\/a><\/figcaption><\/figure><\/div>\n\n<h2 class=\"wp-block-heading\">\u00c9paississement pleural et irr\u00e9gularit\u00e9 de la ligne pleurale  <\/h2>\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img decoding=\"async\" src=\"https:\/\/clarius.com\/wp-content\/uploads\/2020\/03\/4-pleural-thickening.gif\" alt=\"\" class=\"wp-image-9873\" \/><figcaption>@yaletung : <em><a href=\"https:\/\/twitter.com\/yaletung\/status\/1238059289094295552\">https:\/\/twitter.com\/yaletung\/status\/1238059289094295552<\/a><\/em><\/figcaption><\/figure><\/div>\n\n<p class=\"wp-block-paragraph\">Une distribution multilobaire des anomalies est fr\u00e9quente. Les lignes de l&rsquo;\u00e9chographie B\ncorrespondent aux opacit\u00e9s en verre d\u00e9poli typiques visualis\u00e9es sur l&rsquo;imagerie CT\n. Les \u00e9panchements pleuraux (autres que les petits \u00e9panchements localis\u00e9s) sont rares.\nLes anomalies sont le plus souvent visualis\u00e9es dans les champs pulmonaires post\u00e9rieurs et inf\u00e9rieurs\n.  <\/p>\n\n<p class=\"wp-block-paragraph\">Dans les premiers stades de l&rsquo;infection, l&rsquo;\u00e9chographie r\u00e9v\u00e8le principalement des lignes B\nfocales. Au fur et \u00e0 mesure que la maladie progresse, les lignes B peuvent devenir multifocales et confluentes,\navec une \u00e9volution ult\u00e9rieure vers des consolidations franches. Les lignes A devraient r\u00e9appara\u00eetre\npendant la convalescence.  <\/p>\n\n<p class=\"wp-block-paragraph\">La sensibilit\u00e9 et la sp\u00e9cificit\u00e9 de l&rsquo;\u00e9chographie pulmonaire pour COVID-19 n&rsquo;ont pas \u00e9t\u00e9 d\u00e9termin\u00e9es\n. La sp\u00e9cificit\u00e9 est probablement faible, \u00e9tant donn\u00e9 que les lignes B peuvent \u00eatre\nvisualis\u00e9es dans tout processus pathologique provoquant une maladie pulmonaire interstitielle (par exemple\n\u0153d\u00e8me pulmonaire, pneumonie, pneumonie virale, fibrose pulmonaire,\nSDRA). <\/p>\n\n<p class=\"wp-block-paragraph\">Il a \u00e9t\u00e9 sugg\u00e9r\u00e9 que pour un patient souffrant d&rsquo;insuffisance respiratoire, une \u00e9chographie pulmonaire\nnormale devrait permettre d&rsquo;\u00e9carter la possibilit\u00e9 d&rsquo;un COVID-19. En fin de compte, l&rsquo;\u00e9chographie pulmonaire\nfournit un point de donn\u00e9es suppl\u00e9mentaire au tableau clinique complet. <\/p>\n\n<p class=\"wp-block-paragraph\"><strong>Contr\u00f4le<\/strong><\/p>\n\n<p class=\"wp-block-paragraph\">Un document de r\u00e9union du 10 mars du Gruppo Italiano per la\nValutazione degli interventi in Terapia Intensiva (GIVITI) d\u00e9crit leur\nexp\u00e9rience actuelle avec COVID-19 chez les patients des soins intensifs. &lt;4&gt; Du point de vue de la surveillance\n, une ligne B diffuse \u00e0 l&rsquo;\u00e9chographie pulmonaire semble bien r\u00e9pondre\n\u00e0 la PEP. Pour les patients pr\u00e9sentant une consolidation post\u00e9ro-lat\u00e9rale et inf\u00e9rieure,\nla pronation semble \u00eatre efficace. <\/p>\n\n<p class=\"wp-block-paragraph\"><strong>R\u00e9f\u00e9rences<\/strong><\/p>\n\n<p class=\"wp-block-paragraph\">1. Xie X, Zhong Z, Zhao W, et al. Chest CT for Typical 2019-nCoV\nPneumonia : Relationship to Negative RT-PCR Testing. <em>Radiology<\/em>\n2020;200343. doi:10.1148\/radiol.2020200343.  <\/p>\n\n<p class=\"wp-block-paragraph\">2. Huang Y, Wang S, Liu Y, et al. A preliminary study on the\nultrasonic manifestations of peripulmonary lesions of non-critical novel\ncoronavirus pneumonia (COVID-19). <em>SSRN<\/em> 2020. doi:10.2139\/ssrn.3544750.  <\/p>\n\n<p class=\"wp-block-paragraph\">3. Peng Q, Wang X, Zhang L. Findings of lung ultrasonography of novel\ncorona virus pneumonia during the 2019-2020 epidemic. <em>Intensive Care Med<\/em>\n2020. doi:10.1007\/s00134-020-05996-6. <\/p>\n\n<p class=\"wp-block-paragraph\">4. Gruppo italiano per la Valutazione degli interventi in Terapia\nIntensiva (GIVITI). COVID ITU Patients &#8211; Italian Experience. 3 mars 2020.\nDisponible \u00e0 l&rsquo;adresse<a href=\"https:\/\/www.dropbox.com\/s\/r2ca63ckaimp1f6\/COVID%20ITU%20Patients%20Italian%20Experience.docx?dl=0\">: https:\/\/www.dropbox.com\/s\/r2ca63ckaimp1f6\/COVID%20ITU%20Patients%20Italian%20Experience.docx?dl=0<\/a>  <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Daniel J. Kim, MD FRCPC Le Dr Kim est m\u00e9decin urgentiste \u00e0 Vancouver. Pour aider les utilisateurs de Clarius \u00e0 comprendre comment ils peuvent utiliser l&rsquo;\u00e9chographie dans le d\u00e9pistage et le suivi de COVID-19, nous avons demand\u00e9 au Dr Kim de r\u00e9diger un article r\u00e9sumant les meilleures pratiques actuelles. Clarius partagera des mises \u00e0 jour&#8230;<\/p>\n","protected":false},"author":4,"featured_media":33612,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","inline_featured_image":false,"footnotes":""},"categories":[929,729],"tags":[],"specialities":[130,54],"class_list":["post-152930","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-education","category-news-fr","specialities-critical-care","specialities-emergency-medicine"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.6 (Yoast SEO v28.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Utilit\u00e9 clinique et technique de l&#039;\u00e9chographie pulmonaire dans les cas COVID-19 | Clarius | Blog Post<\/title>\n<meta name=\"description\" content=\"Daniel J. 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