Please see this article on why we should all practice ultrasound in critical care!

Chest Ultrasound – Compendium of Scans

Click on the Top left arrow icon to see all scans in the series!

 

Pictorial Section

Probe Positions

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A lines – Basic

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B Lines

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B lines in the interlobular septa – pulmonary oedema.
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Multiple B-lines that go all the way to the edge of the screen and that obliterate the A-lines is not normal. More than 5 in an area is very much abnormal and correlates with extra-vascular lung water or pulmonary oedema
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B lines – more confluent so more likely to be in alveoli as well.

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Pleural Effusions

Use your echo cardiac phased array probe for this!

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Move the probe caudad and cephalad until you can see the diaphragm clearly
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No fluid here, so liver and lung look the same above and below the diaphragm

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Pneumonia

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Pneumothorax

See also our section on images in pneumothorax

In a blunt trauma series, pneumothorax detection:

  • CXR sensitivity 75%, specificity 100%
  • EUS sensitivity 98%, specificity 99%
    • Using multiple windows, we are able to assess the size of the pneumothorax with good correlation.
    • You can do this by mapping out “lung point” which is the point where the lung drops away from the chest wall. And doing this you can get a good idea of what size the pneumothorax is.
      13:54: Pneumothorax Scanning Technique
  • Linear high frequency probe needed
    • Place the probe cephalad-caudad with the indicator towards the head.
    • Place it in the 2nd intercostal space in the mid-clavicular line in (again) a vertical orientation.
      You want to watch four to five respiratory cycles.
  1. Identify the pleural line
  2. Observe lung sliding
  3. Sky-Ocean-Beach interface on M-mode

Other causes of absent lung sliding:

  • Effusions
  • Consolidation with pleural adhesions
  • Chest tubes
  • Advanced COPD

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Horizontal lines replace the granular looking lung = probable pneumothorax

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Protocols!

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Modified BLUE Protocol – Licshtenstein

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