Advertisement

Thoracic Ultrasound

  • Michael Joyce
  • Angela B. CredittEmail author
Chapter
  • 1.2k Downloads

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.

Keywords

Pulmonary edema Pneumonia Pleural effusion Pulmonary contusion Pneumothorax Lung sliding B-lines 

Supplementary material

Video 4.1

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)

Video 4.2

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)

Video 4.3

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)

Video 4.4

Pneumothorax: When there is a pneumothorax present, lung sliding will be absent, and the bright white pleural line will appear still (MP4 481 kb)

Video 4.5

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)

Video 4.6

Abnormal B-lines: Diffuse B-lines taking up the entire lung field suggest pulmonary edema in the right clinical setting (MP4 446 kb)

Video 4.7

Consolidation: Disruption of the pleural line due to consolidation of the lung tissue (MP4 1995 kb)

Video 4.8

Pulmonary contusion: In the setting of trauma, isolated B-lines suggest pulmonary contusion (MP4 1976 kb)

Video 4.9

Pleural effusion: A small pleural effusion is noted above the diaphragm (MP4 1937 kb)

References

  1. 1.
    Silva FR, Mills LD. Chapter 7: Pulmonary. In: Ma OJ, Mateer JR, Reardon RF, Joing SA, editors. Emergency ultrasound. 3rd ed. China: McGraw-Hill Education; 2014. p. p169–90.Google Scholar
  2. 2.
    Saraogi A. Lung ultrasound: present and Future. Lung India. 2014;32(3):250–7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429387/. Accessed 25 April 2017 (Lung).CrossRefGoogle Scholar
  3. 3.
    Husain LF, Hagopian L, Wayman D, Baker WE, Carmody KA. Sonographic Diagnosis of Pneumothorax. Journal of Emergencies, Trauma, and Shock. 2012;5(1):76–81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299161/ Accessed 26 April 2017.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Durant A, Nagdev A. Ultrasound Detection of Lung Hepatization. Western Jounral of Emergency Medicine. 2010;11(4):322–3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967681/. Accessed 26 April 2017 (US Detect).Google Scholar
  5. 5.
    Martindale JL, Wakai A, Collins SP, Levy PD, Diercks D, Hiestand BC, Fermann GJ, deSouza I, Sinert R. Diagnosing acute heart failure in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2016;23(3):223–42.CrossRefPubMedGoogle Scholar
  6. 6.
    Lee FCY. Lung ultrasound—a primary survey of the acutely dyspneic patient. J Intensive Care. 2016;4(1):57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007698/. Accessed 26 April 2017.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Prina E, Torres A, Roberto C, Carvalho R. Lung ultrasound in the evaluation of pleural effusion. J Bras Pneumol. 2014;40(10):1–5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075927/. Accessed 26 April 2017.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Emergency MedicineVirginia Commonwealth University Medical CenterRichmondUSA

Personalised recommendations