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Intro to Bedside Ultrasound
Pulmonary Ultrasound
University of California-Irvine School of Medicine
Nathan Molina nathan.d.molina@gmail.com Trevor Plescia taplescia90@gmail.com Jack Silva jpsilva42@gmail.com
TEACHERS
General Positioning
Anterior zones: Air (pneumothorax)
Posterior/Lateral zones: Fluid (pleural effusion, hemothorax)
AIR
FLUID
Convex or linear probe Position the transducer perpendicular to the ribs such that the
monitor displays two rib shadows (with an intercostal space in between)
Anterior Approach
Visceral pleura covering the lungs
Parietal pleura covering the inner chest wall
The VPPI is the space between the 2 layers of pleura
Appears hyperechoic relative to surrounding tissue
Ultrasound is used to visualize the movement of the pleural layers against each other
Visceral Parietal Pleural Interface (VPPI)
VPPI
VPPI A normal VPPI will look like “ants on a log”
There are 3 types of artifacts that are very useful for pulmonary ultrasound A lines
B lines
Mirror image artifact
Artifacts
Caused by reverberation of sound waves off of the VPPI
A-Lines are normal
VPPI
A-Lines
B-lines are seen when fluid replaces air in the lungs
They are well-defined, hyperechoic, vertical artifacts that erase A-lines
A normal patient can have up to 4 B-lines
Multiple, diffuse B-lines is an abnormal finding and suggests the presence of interstitial or alveolar fluid
B-Lines
11
Fluid in between the interlobular septa (normal) can produce some B-lines
Excess fluid in the interlobular septa and fluid in the alveoli (abnormal) will produce several B-lines
B-Lines
VPPI: Visceral Parietal Pleural Interface
A lines: HORIZONTAL reverberation artifacts from VPPI; equidistant from each other
Seen in normal patients
B lines: VERTICAL, hyperechoic artifacts
Up to 4 B-lines can be seen in normal patients
Many diffuse in patients with interstitial edema
These can all be visualized with both the linear and the convex transducer
Artifacts Summary
M-Mode is used to highlight moving structures
In M-Mode, horizontal lines represent static structures (no motion)
Everything else indicates moving structures
A normal lung will have a “Sky-Ocean-Beach” appearance in M-Mode
A lung with air in the VPPI (pneumothorax) will have a “Barcode” appearance in M-Mode
M-Mode
Sky-Ocean-Beach
NORMAL
Sky = Skin, subcutaneous tissue, fat
Ocean = Muscle, VPPI
Beach = lung tissue
Barcode (PTX)
Lateral Approach (Coronal)
Coronal view including the diaphragm
Indicator pointed to the head of the patient
Convex or phased array transducer
Assessing for Pleural Effusion
Mirror Image of Liver (Normal)
Normal Spine Sign
Pleural Effusion (no mirror image + abnormal spine sign)
On the left side of the body, we can assess for pleural effusion by scanning the spleen and looking for its mirror image.
Bacterial infections (such as pneumonia) cause consolidation of the lung parenchyma as the infections are resolved
Creates a characteristic liver-like appearance (hepatization)
The lung will appear hypoechoic, with many small, hyperechoic lines dispersed throughout it
Pneumonia
Hepatization of the Lung
Thank you!
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