Abstract
A few seconds are sufficient to rule out pneumothorax, less than 1 min to rule it in, at the bedside. This justifies the length of the present chapter.
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Basic A’-profile. Historical image, a pneumothorax diagnosed with the ADR-4000 (a 1982 technology). Note from top to bottom the absence of dyspnea, the pleural line (clearly defined using the bat sign), perfectly standstill – no lung sliding, and the Merlin’s space occupied by four exclusive A-lines (MOV 2335 kb)
Pneumothorax and stratosphere sign. Left, a pneumothorax using a Hitachi-405 (1992 technology). Right, both Keye’s space and M-Merlin’s space display stratified lines, generating the stratosphere sign. Note this basic feature: both images move together, a feature not possible in very modern machines (MOV 2246 kb)
Dyspnea, the Keye’s sign and the Avicenne sign. In this dyspneic patient, the abolition of lung sliding, on real time, is not that obvious, because of the muscular contractions, superficial to the pleural line. The Merlin’s space displays subtle A-lines. On M-mode, the Keyes’ space shows a parasite dynamic from muscular contractions. These accidents are displayed in the M-M space without any change when crossing the pleural line: the Avicenne sign, demonstrating the abolished lung sliding with no confusion (MOV 2640 kb)
Pneumothorax and the lung point. Dyspneic patient. The probe, searching for a lung point because of an A’-profi le, fi nds suddenly, near the PLAPS-point in this patient, a sudden change,from a lateral A’-profi le (no lung sliding, only A-lines) to a transient lateral B-profi le (fl eeting lung sliding, fl eeting lung rockets), in rhythm with respiration during the acquisition. This is the pathognomonic sign of pneumothorax. Example here of lateral lung point (MOV 7181 kb)
No pneumothorax despite severe subcutaneous emphysema. The image fi rst shows the Cornu’s sign; then the operator tries to withdraw the gas collections. At 15”, a hyperechoic line is identifi ed, fi rst oblique (the probe was not fully perpendicular). The probe stabilizes it on the screen, making it horizontal at 21”. A lung sliding is visible. At 25”, the M-mode shows a seashore sign, i.e., defi nite absence of pneumothorax (MOV 2335 kb)
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Lichtenstein, D.A. (2016). Pneumothorax and the A’-Profile. In: Lung Ultrasound in the Critically Ill. Springer, Cham. https://doi.org/10.1007/978-3-319-15371-1_14
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DOI: https://doi.org/10.1007/978-3-319-15371-1_14
Publisher Name: Springer, Cham
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