Pulmonary Ultrasound

  • Nathan LudwigEmail author
  • Ahmed F. Hegazy


Pulmonary ultrasound, as a diagnostic tool, is rapidly increasing in its adoption in acute care specialties. With relative ease, frontline clinicians can learn a few simple pulmonary sonographic signs, enabling them to narrow down the differential diagnosis of respiratory failure in a very expeditious manner. Accurate assessments of lung fluid overload, pneumothorax, lung consolidation, and pleural effusions are all readily performed using ultrasound with much greater sensitivity than chest X-rays. Mastering this technique, however, requires an understanding of the physical principles that are key to the development of pulmonary sonographic artifacts and ultrasound findings. A method of collecting, storing, and labeling images taken in each hemithorax is described in this chapter. In addition, state-of-the-art practical perioperative applications of pulmonary ultrasound are discussed. When used in conjunction with a clinical assessment, pulmonary ultrasound can be used for interval scanning of critically ill patients, eliminating or decreasing the need for serial chest X-rays or CT scans, and, more importantly, guiding informed patient management decisions.


Ultrasound Ultrasonography Pulmonary ultrasound Point of care Lung Pleura Perioperative 

Supplementary material

Open image in new windowFig. 28.12
Video 28.1

Lung sliding and A-lines. Image obtained using a curvilinear probe, with rib shadows causing acoustic shadowing. Pleural line shows a slow back and forth movement with respiration (lung sliding). Underneath the pleural line, horizontal equidistant repetitious lines (A-line artifacts) are observed. The presence of both lung sliding and A-lines indicates the absence of pneumothorax and normal lung aeration at the point of probe placement (MOV 1760 kb)

Video 28.2

Lung pulse and A-lines. Image obtained using a phased array probe. Pleural line showing a fast shimmering coinciding with cardiac activity (lung pulse). The presence of a lung pulse indicates the absence of a pneumothorax at the point of probe placement. Underneath the pleural line, a horizontal A-line artifact is observed (MP4 634 kb)

Video 28.3

Absent lung sliding. Pleural line showing no lung sliding. This is suggestive of a pneumothorax but is not specific. Image obtained using a phased array transducer (MP4 221 kb)

Video 28.4

Lung point. The transition point between sliding and absent lung sliding is demonstrated. This is very specific for pneumothorax (specificity 100%) (MP4 201 kb)

Video 28.5

B-lines characteristics. B-lines extending from the pleural line to the end of the screen and moving synchronously with lung sliding. As seen in this video, three or more B-lines (or a coalescence of B-lines) are considered pathological (MP4 450 kb)

Video 28.6

Consolidated (hepatized) lung with dynamic air bronchograms. Consolidated lungs could be secondary to pneumonia or atelectasis. Dynamic air bronchograms (seen in this video) are commonly seen with pneumonia, but are not necessarily specific (MP4 784 kb)

Video 28.7

Pleural effusion (dynamic features). Pleural effusion characterized by being an anechoic space, within typical anatomical boundaries, with dynamic features. Diaphragmatic descent, as a dynamic feature, is demonstrated (MP4 585 kb)

Video 28.8

Plankton sign. Floating debris, moving with cardiac activity and diaphragmatic movement within a pleural effusion, is named the “plankton sign.” Also note the different densities within the effusion fluid which also favors this being an exudative process (MP4 1279 kb)

Video 28.9

B-line predominance in the right anterior chest wall. Multiple vertical hyperechoic comet tails on pulmonary ultrasound. This B-line predominance indicates abnormal lung aeration at the point of probe application (MP4 1069 kb)

Video 28.10

B-line predominance in the right anterior axillary line. A coalescence of B-lines is demonstrated, indicating abnormal lung aeration at the point of probe application. Diffuse homogeneous B-line predominance is very characteristic of pulmonary edema (MP4 708 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyWestern University, London Health SciencesLondonCanada
  2. 2.Departments of Anesthesiology and Critical Care MedicineWestern University, London Health SciencesLondonCanada

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