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
Page 1 on the FATE card is used for this part of the FATE examination
Position 4 is indicated on the FATE torso in the lower right corner of page 1 on the FATE card
The target image is displayed in the lower left corner of page 1 on the FATE card
Study the FATE card and memorize position 4 and the target image before beginning the examination
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
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
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
