Patients with cardiac arrest – 2D echocardiography

The characteristics are:

– Immobile myocardium
– Fibrillation

Possibly reversible causes for the cardiac arrest which can be recognised with ultrasound are:

– Pericardial effusion
– Hypovolemia
– Pleural effusion
– Dilated right side (pulmonary embolus signs)
– Dilated left side

The 2D echocardiographic characteristics of pulmonary edema

Look for:
– B-lines

B-lines are white laser-like beams that have their origin from the pleural line and continues to the far end of the image

B-line characteristics:
– One to three is normal at the basic parts of the lungs (position 4)
– B-lines are not normal at the anterior part of thorax
– With increasing amount of lung water the number and density of the B-lines will increase
– The presence of B-lines excludes pneumothorax at the scanning point (pneumothorax can be present in other parts of the thorax)

Pulmonary edema – typical clinical conditions

Should be considered in particular with the following conditions:

– All respiratory compromising conditions
– All conditions with hemodynamic instabillity
– All cardiac failure patients
– COPD exacercabtion
– Shortness of breath, especially if arterial hypertension or hypotension is present
– Volume overload, verified or suspected
– Renal failure

The images and the video clip show 4 examples of pleural effusion

Notice:

– Black (or greyish) fluid collection in the thoracic cavity above the diaphragm
– Atelectasis of the lung
– Diaphragm is clearly visible
– Lung sliding is absent in the phrenicocostal sinus

Multiple B-lines in a patient with pulmonary edema

Notice that the B-lines start from the pleural line and extends to the far end of the screen = 30 cm in depth

The presence of lung or pleural sliding during positive pressure ventilation on both sides ensures correct placement of the endotrachial tube

The evaluation can take place anywhere on the thorax wall

The recording shows lung or pleural sliding in position 4

Notice: B-lines are present in D (normal finding in position 4 even in healthy people)

Pleural effusion – typical clinical conditions

Should be considered in particular with the following conditions:

– All respiratory compromising conditions
– All conditions with hemodynamic instabillity
– All ICU patients
– All cardiac failure patients
– Cardio-thoracic surgery patients
– Infection
– Renal failure

Different presentations of aortic valve sclerosis (white arrows) in the parasternal long axis view

Only image B has normal LV function

Findings in patient with endocarditis affecting the tricuspid valves. The video clips A and D are from the same patient

A, C and D are subcostal views for optimal display of the pedunculated masses

B is a modified 4-chamber view for optimal display of the pedunculated masses

The 2D echocardiographic characteristics of pleural effusion

Look for:

– Black fluid in the thoracic cavity – above the diaphragm (fluid can appear greyish)
– Atelectasis of the lung
– Diaphragm unusually clearly visible
– Lung sliding is absent in the phrenicocostal sinus