Bodytext1 The focused question regarding pleural effusion is:
Is fluid present in the pleural space?
The question is answered by using ultrasound imaging for detection of an anechoic (black) area above the diaphragm on either the left or the right side of the lower, posterior part of the thorax
The patient must be in supine or sitting position, preferably with elevated thorax so that the fluid is moved down/back
Beware: Patients placed in the Trendelenburg position may not show fluid due to movement of fluid into the apical area of the lung
Fact text: The image shows pleural effusion on the right side of the body (top) and on the left side of the body (bottom)
Observe the black area above the diaphragm indicating pleural effusion
Bodytext1 The videos recorded at the lower limit of the right side of the thorax show presence and absence of pleural effusion in two different patients
In the recording from the patient without pleural effusion (right), a black area is absent above the diaphragm and during inspiration the “curtain sign” is present and the “spine” sign absent
Presence of normal lung ultrasound signs and the “curtain sign” hiding the organs below the transducer during inspiration rule out pleural effusion.
The recording in the patient with pleural effusion (left) shows a black area above the diaphragm consistent with pleural effusion
No lung ultrasound signs are visible in the costophrenic recess, and no “curtain sign” is seen
Click on the VIDEO CLIP button to view the video
Fact text: The videos show lung ultrasound in two patients with and without pleural effusion
Observe the black area above the diaphragm in the patient with pleural effusion (left), and the normal lung ultrasound signs and the “curtain sign” coming into view on the monitor during inspiration in the patient without pleural effusion (right)
Bodytext1 Evaluation of pleural effusion corresponding to zone 3 on the right side of the thorax is performed by:
1. Placing the ultrasound transducer in the medioaxillary line at the lower limit of the right hemithorax 2. Identifying the liver 3. Moving the transducer cranially until the diaphragm is seen 4. Demonstrating or excluding the presence of a pleural effusion using: – Presence or abscence of curtain sign? – Presence or abscence of spine sign?
The principles for assessment of zone 5 are the same, the only difference being that the transducer is typically placed in the medioclavicular line at the posterior side of the chest
Fact text: The video shows how to evaluate presence of pleural effusion in the right pleural space
Bodytext1 A systematic approach will help: – Place the probe beam parallel to the vertical plane
– Ensure that the OM of the transducer is oriented cranially and that the corresponding OI is placed on the left side of the screen. (In this way the cranial end of the transducer is always displayed towards the left side of the monitor)
Bodytext1 B-line(s) is a lung artefact generated by an increased density of the underlying lung tissue. An example is when subpleural interlobular septae become edematous in cardiogenic pulmonary edema
A B-line is a hyperechoic, laser-like, vertical, reverberation artefact originating from the pleural line
B-lines are continuous from the pleural line to the bottom edge of the screen and do not fade in intensity
Few narrow B-lines can be seen in healthy persons, while multiple and wide B-lines suggest pathology
B-lines are used in emergency lung ultrasound to confirm or exclude the presence of pneumothorax and/or interstitial syndrome (ie. pulmonary edema)
Fact text: The image shows a lung ultrasound picture obtained with an abdominal curved array probe Rib and pleura are marked Arrows indicate a narrow (A) and a wider (B) B-line
Bodytext1 In dynamic views B-lines move back and forth in synchrony with the lung sliding in real time
Fact text: The videos display lung ultrasound recorded with an abdominal transducer At the top, a few B-lines can be seen as vertical, hyperechoic (white), and sharply demarcated lines originating from the pleura line At the bottom, multiple closely spaced B-lines are visible
