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KEY IMAGES

Bilateral lung apices/anterior/midlung

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Video 06-01: A lines

Lung ultrasound requires identification of the relevant anatomy. With the transducer held longitudinally, with the indicator cephalad, that includes the superior and inferior rib (seen as hyperechoic lines with dense shadows) and the pleura (a bright hyperechoic line just deep to the ribs). The pleura can be seen shimmering or glistening when normal pleural dynamics are observed. This video also demonstrates A-lines, arising as a result of the reverberation artifact between the pleura and the transducer. This is consistent with normal lung parenchyma in this video.

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Hand position for all views, anchor hand on skin

Bilateral lung bases

Anterior and posterior axillary lines starting at level of diaphragm and sliding up until lung curtain

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Video 06-02: Lung curtain

At the base of the lung it is important to identify the diaphragm and the underlying viscera. In this case, the video was taken on the patient's right side, so the liver and diaphragm can be seen on the right side of the screen. The left side of the screen is lung parenchyma (remember that left is cephalad and right is caudad). As the patient inspires, a curtain of grey air artifact sweeps from left (superior) to right (inferior) obliterating the view of the diaphragm and liver. This effectively rules out pleural effusion at this location.

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Hand position for lung base, anchor hand on skin

B-mode lung sliding

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Video 06-03: Lung sliding

Using the linear transducer allows a much higher resolution evaluation of the pleura. The glistening and shimmering is much more apparent, especially in comparison to the fascial planes and muscle fibers more superior to the pleura. Small vertical artifacts are also visible at several places during the respiratory cycle. These have no pathological significance, but also rule out pneumothorax at that location.

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M-mode lung sliding

ACQUISITION TIPS

  • Most lung ultrasound findings are actually ultrasound artifacts. Use the Lung Exam preset to avoid the suppression of artifacts. If you do not have this preset, turn off multibeam imaging and set “persist” to 0 (which turns off frame averaging).

  • Video clips are preferred to stills because of the dynamic nature of lung ultrasound findings.

  • The curvilinear and phased-array probes are preferable for viewing structures deep to the pleura ...

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