Abstract
Frequently patients with numerous comorbidities seek the care of a physician for evaluation of shortness of breath. Thoracic ultrasound has improved our diagnostic capability to rapidly determine the cause of their symptomology and guide management, which is specifically advantageous in patients with respiratory distress. It can diagnose conditions such as pneumothorax, pulmonary edema, pleural effusion, or pneumonia. Importantly, thoracic ultrasound can help differentiate between chronic obstructive pulmonary disease exacerbations and decompensated heart failure, two common conditions that can appear similar, be quite severe, and require vastly different treatment. Thoracic ultrasound is easy to learn and quick to employ and can be potentially lifesaving for patients. This chapter will review the indication, basic anatomy, image acquisition, normal ultrasound anatomy, and interpretation of pathology.
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B-lines: B-lines extend from the pleural line down to the bottom of the screen without fading. It is normal to have up to three B-lines in one field of view (MP4 1536 kb)
Hepatization: Lung tissue above the diaphragm on the left side of the image appears similar to liver tissue below the diaphragm on the right side of the image. Also noted is a pleural effusion (MP4 494 kb)
Lung sliding: The bright white hypoechoic line represents the interface of the parietal pleura and visceral pleura. With inspiration and expiration, the two pleural lines will move against each other in a to-and-fro movement (MP4 1560 kb)
Pneumothorax: When there is a pneumothorax present, lung sliding will be absent, and the bright white pleural line will appear still (MP4 481 kb)
Lung point sign: On the left side of the screen, normal lung sliding meets the absence of lung sliding due to a pneumothorax, known as lung point sign (MP4 488 kb)
Abnormal B-lines: Diffuse B-lines taking up the entire lung field suggest pulmonary edema in the right clinical setting (MP4 446 kb)
Consolidation: Disruption of the pleural line due to consolidation of the lung tissue (MP4 1995 kb)
Pulmonary contusion: In the setting of trauma, isolated B-lines suggest pulmonary contusion (MP4 1976 kb)
Pleural effusion: A small pleural effusion is noted above the diaphragm (MP4 1937 kb)
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Joyce, M., Creditt, A.B. (2018). Thoracic Ultrasound. In: Clinical Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-68634-9_4
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DOI: https://doi.org/10.1007/978-3-319-68634-9_4
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