Advertisement

Pneumothorax and the A’-Profile

  • Daniel A. Lichtenstein

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.

Keywords

Lung Ultrasound Pleural Line Cardiac Probe Interstitial Syndrome Nondependent Lung 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 14.1

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)

Video 14.2

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)

Video 14.3

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)

Video 14.4

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)

Video 14.5

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)

References

  1. 1.
    Chiles C, Ravin CE (1986) Radiographic recognition of pneumothorax in the intensive care unit. Crit Care Med 14:677–680CrossRefPubMedGoogle Scholar
  2. 2.
    Lichtenstein D, Holzapfel L, Frija J (2000) Projection cutanée des pneumothorax et impact sur leur diagnostic échographique. Réan Urg 9(Suppl 2):138Google Scholar
  3. 3.
    Lichtenstein D, Mezière G, Lascols N, Biderman P, Courret JP, Gepner A, Goldstein I, Tenoudji-Cohen M (2005) Ultrasound diagnosis of occult pneumothorax. Crit Care Med 33:1231–1238CrossRefPubMedGoogle Scholar
  4. 4.
    Lichtenstein D, Menu Y (1995) A bedside ultrasound sign ruling out pneumothorax in the critically ill: lung sliding. Chest 108:1345–1348CrossRefPubMedGoogle Scholar
  5. 5.
    Hoppin F (2002) How I, review an original scientific article. Am J Respir Crit Care Med 166:1019–1023CrossRefPubMedGoogle Scholar
  6. 6.
    Lichtenstein D, Mezière G, Biderman P, Gepner A (2000) The lung point: an ultrasound sign specific to pneumothorax. Intensive Care Med 26:1434–1440CrossRefPubMedGoogle Scholar
  7. 7.
    Lichtenstein D, Mezière G (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure. The BLUE-pr laurenceotocol. Chest 134:117–125CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Lichtenstein D, Mezière G, Biderman P, Gepner A (1999) The comet-tail artifact, an ultrasound sign ruling out pneumothorax. Intensive Care Med 25:383–388CrossRefPubMedGoogle Scholar
  9. 9.
    Brügmann L (2007) Acoustic artifacts. In: Schmidt G (ed) Précis d’échographie. Maloine, Paris, pp 18–23Google Scholar
  10. 10.
    Stone MB, Chilstrom M, Chase K, Lichtenstein D (2010) The heart point sign: description of a new ultrasound finding suggesting pneumothorax. Acad Emerg Med 17(11):e149–e150CrossRefPubMedGoogle Scholar
  11. 11.
    Rantanen NW (1986) Diseases of the thorax. Vet Clin North Am 2:49–66Google Scholar
  12. 12.
    Wernecke K, Galanski M, Peters PE, Hansen J (1989) Sonographic diagnosis of pneumothorax. ROFO Fortschr Geb Rontgenstr Nuklearmed 150:84–85CrossRefPubMedGoogle Scholar
  13. 13.
    Targhetta R, Bourgeois JM, Balmes P (1992) Ultrasonographic approach to diagnosing hydropneumothorax. Chest 101:931–934CrossRefPubMedGoogle Scholar
  14. 14.
    Copetti R, Cattarossi L (2007) The “double lung point”: an ultrasound sign diagnostic of transient tachypnea of the newborn. Neonatology 91(3):203–209CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Daniel A. Lichtenstein
    • 1
  1. 1.Hôpital Ambroise Paré Service de Réanimation MédicaleBoulogne (Paris-West University)France

Personalised recommendations