Video 07-01: Left lung base
This video shows the left lung base in a patient with a large simple effusion. The spleen and overlying diaphragm are on the right side of the screen. The densely atelectatic lower lobe can be seen moving with respirations. Also visible is the heart (in this case a short axis view). The heart can be seen to have a decreased ejection fraction, which was the underlying cause of this effusion.
Hand position, patient able to sit
Video 07-02: Right lung base
This video shows the right lung base, where the liver and overlying diaphragm are on the right side of the screen. Anechoic fluid is labeled, and during the respiratory cycle the grey air artifact can be seen coming in as a curtain from the left side of the screen. Also visible is a rib shadow that can be distinguished from the fluid using posterior acoustic enhancement.
Hand position, supine patient
Identify your target rib to ensure needle goes superior to rib
Video 07-03: Rib shadow
In this video the operator is sliding the probe superiorly through a large effusion. Initially the diaphragm and underlying viscera are visible on the right side of the screen. As the probe slides superiorly the rib shadows can be seen moving across the screen from left to right. They can be distinguished from fluid using the posterior acoustic enhancement of the fluid. Notable is the large area of atelectatic lung in the effusion.
Depth measurement, still image
Superior to a rib, measure depth of soft tissue and depth of fluid
Video 07-04: Depth measurement
The linear transducer prevents visualization of deeper structures, but allows a high resolution evaluation of the soft tissues and measurement of the depth of the effusion. In this case, the effusion can be seen to be very shallow at the location selected, with 2.1 cm of tissue and only 1-2 cm of free fluid. This effusion would be considered high risk for thoracentesis, and real-time guidance should be considered if the tap is indicated.
Measure from lung to diaphragm