Lung inflammation is a serious complication seen in many systemic connective tissue diseases (Lupus, Scleroderma, Dermato-/Poly-myositis) and Rheumatoid Arthritis.
Typically, high resolution CT scan is done to diagnose and monitor the condition, with the need to differentiate between active inflammation (requiring intensified immunosuppression) and scarred tissue (all water under the bridge, sadly).
HRCT is expensive and comes with ionising radiation. If a safe and inexpensive screening and monitoring tool like ultrasound is validated to yield similarly accurate results, it is a boon indeed.
Quantitative Contrast-Enhanced Ultrasound Parameters in Crohn Disease: Their Role in Disease Activity Determination With Ultrasound
Crohn’s Disease that affects the small intestines predominantly can be difficult to diagnose and monitor.
Traditionally, capsule video-enteroscopy is done, involving the patient swallowing a large capsule containing a video camera, which will record hours of images of the small intestines, which then gets passed out a day or 2 later, and the long footage gets viewed and interpreted by an expert. This is understandably tedious, and does not give information regarding inflammation within the wall of the intestines.
Similarly expensive are PET-CT or PET-MR, but more informative regarding wall inflammation or scarring.
With contrast-enhanced ultrasound, the evaluation is non-invasive, relatively cheaper, and fairly accurate in distinguishing active inflammation from old scarring.
Large vessel vasculitides like Takayasu Arteritis and Giant Cell Arteritis are diagnostic and monitoring challenges.
Without a high index of suspicion, diagnosis is often missed for years, until some catastrophic event like blindness, stroke or heart attack occurs. Diagnosis is often confirmed on angiogram or PET-CT.
Systemic inflammatory markers like ESR and CRP may not be high despite active disease, and symptoms do not become apparent till (too) late. Monitoring of disease activity to guide treatment is therefore expensive: PET-CT.
With mounting evidence that CEUS is both accurate, non-ionising and fairly cheap, it should eventually become the method of choice.
Ultrasound contrast can help treat heart attacks
While rheumatologists are welcoming musculoskeletal ultrasound with open arms as the technological extension of our clinical examination (calling it the rheumatologist’s stethoscope), some stalwarts in some disciplines may still view it as an affront to their time/ego-honoured clinical acumen.