Structures identified in the FATE position 4 – the pleural view

On the right side of the patient:
– liver
– diaphragm
– lung tissue

On the left side of the patient:
– spleen
– diaphragm
– lung tissue

The diaphragm is a mandatory landmark to identify and display clearly on the screen

The scanning planes of the pleural views are coronal (frontal)

The orientation marker (OM – green spot) on the transducer is directed cranially

Due to the convention of cardiac ultrasound, the orientation indicator is placed on the right side of the screen. Consequently, the lungs are displayed on the right side of the screen, and the solid organs on the left side of the screen.

The solid organs below the diaphragm are:
– the liver (the patient’s right side)
– the spleen (the patient’s left side)

Pleural effusion, if present, will appear between the diaphragm and the lung surface

The two pleural views are obtained on the lower left and right side of the thorax respectively

The pleural views are obtained by placing the transducer as illustrated on the torso

The orientation marker on the transducer is pointing cranially

In the following we will go through the positions in detail, focusing on how to obtain and interpret the 2D ultrasound image

This view is suitable for assessment of global and regional left ventricular function as myocardium with blood supply from all three coronary arteries are represented

The image quality is often improved with expiration

The left lateral position – approx. 80 degree – is generally the optimal position

In basic FATE the PSAX view should be obtained at the mid papillary level

The FATE position 4 is called the pleural view

Two different views are obtained in the FATE position 4:
– The left side pleural view
– The right side pleural view

The position obtained in position 4 is displayed on page 1 of the FATE card

The pleural views are suitable for a quick evaluation of:
– pleural effusion
– atelectasis
– pulmonary edema

You will now be taken through the positions in detail, focusing on how to obtain and interpret the images

You have now learned:

– The anatomy of the FATE position 3, the parasternal long and short axis views
– How to obtain the correct image with respect to transducer orientation and the relationship
to the presentation on the screen

Review if you are not confident about how to obtain the view and identify the structures of the heart

When you feel confident move on to FATE position 4, the pleural view

The structures identified in the FATE position 3, parasternal short axis view are

– RV: Right ventricle
– LV: Left ventricle
– ALPM: Antero-lateral papillary muscle
– PMPM: Postero-medial papillary muscle
– IVS: Inter-ventricular septum
– LW: Lateral wall
– PW: Posterior wall
– Pericardium