ABSTRACT
Normal lung is dicult to assess using transesophageal echocardiography (TEE). However, TEE can more easily
evaluate abnormal lung4 and detect pleural eusion and hemothorax.5-7 The CAE Vimedix simulator can demonstrate how to use TEE for the examination of the lung.8 A key principle of lung evaluation is to obtain simple reference points from which known lung segments can be localized and identified if abnormal. Both the le and right lungs are divided into basal, mid and apical portions (Figure 4.1). The intrathoracic part of the inferior vena cava (IVC), right upper pulmonary vein (RUPV), le upper pulmonary vein (LUPV), superior vena cava (SVC) and le subclavian artery (LSCA) are the landmarks used to separate basal from mid and mid from apical portions (Figure 4.2). Lower esophageal (LE), mid-esophageal (ME) and upper esophageal (UE) views at 90° can evaluate the respiratory system using TEE (Figure 4.3). Alternatively the position of the TEE probe in relation to a clock can localize the ultrasound beam position (Figure 4.4). Consequently using TEE, le lung regions can be divided into le anterior (11-12 o’clock), anterolateral (10 o’clock), lateral (9 o’clock), and posterior (8 o’clock) (Figure 4.3). The right lung is divided into right anterior (12-1 o’clock), anterolateral (2 o’clock), lateral (3 o’clock), and posterior (4 o’clock) (Figure 4.3). Each of these lung sections are further subdivided into basal, mid, and apical levels (Figures 4.5 and 4.6). Using this approach, abnormal pulmonary segments or pleural pathologies adjacent to the esophagus can be identified and monitored. Precise intraoperative localization of pulmonary pathologies permits close monitoring and helps determine the eect of therapy such as lung recruitment. Table 4.1 summarizes the steps used to perform the TEE exam of the respiratory system.
