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Review
. 2015 Aug;5(4):618-23.
doi: 10.3978/j.issn.2223-4292.2015.05.04.

Bedside ultrasonography for diagnosis of pneumothorax

Lin Chen  1 , Zhongheng Zhang  1
Affiliations
Review

Bedside ultrasonography for diagnosis of pneumothorax

Lin Chen et al. Quant Imaging Med Surg. 2015 Aug.

Abstract

Ultrasonography (US) has found its way into the critical care and emergency settings for the evaluation of acute respiratory failure conditions in recent years. It is useful for the diagnosis of varieties of abnormalities involving pleura and lung such as pleural effusion, alveolar interstitial syndrome, and pneumothorax (PTX). In addition to its reproducibility and timeliness, US has high sensitivity and specificity for the diagnosis of these conditions. The most widely used method for bedside evaluation of PTX is chest X-ray (CXR). However, the diagnostic sensitivity of CXR in detecting PTX is limited especially in occult PTX and when the patient is assumed supine position. Computed tomography (CT) is the gold standard in the evaluation of PTX, but is limited by its high radiation exposure and safety concerns in transporting critically ill patients. In this paper we review current advances in PTX diagnosis using US.

Keywords: Critical care; lung point; pneumothorax (PTX); ultrasonography (US).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Basic structures of lung ultrasound (9). The so-called lung sliding identified at pleural line of the normal lung represents the cyclic movement between the visceral and parietal pleura with spontaneous respiration. Available online: http://www.asvide.com/articles/672
Figure 2
Figure 2
Seashore sign in normal lung. Since the structure above the pleural line is static during respiration, it produces parallel lines that look like waves in M-mode. Beneath the pleural line, the cyclic movement of lung with respiration produces sand-like appearance.
Figure 3
Figure 3
A-line in normally aerated lung. The A-line artefact is horizontal artifactual repetitions of the pleura line. A-lines are often presented in normal lung, indicating that the lung is well aerated.
Figure 4
Figure 4
B-line is the vertical line that is perpendicular to the pleural line and its appearance represents fluid accumulation in the alveoli. Typical B-line can be best viewed with multi-beam function switched off (B), and it appears to be multiple lines emitting from a single point when MB is switched on (A).
Figure 5
Figure 5
Barcode or stratosphere sign typically found in patients with pneumothorax. In the pleural line the lung sliding is abolished and the sand-like appearance beneath the pleural line is replaced by parallel lines which is termed stratosphere or barcode sign.
Figure 6
Figure 6
The presence of lung pulse to exclude pneumothorax (11). Lung pulse is produced by transmission of cardiac pulse to pleural line, given that the visceral and parietal pleura contact with each other. Available online: http://www.asvide.com/articles/673
Figure 7
Figure 7
Lung sliding is present in healthy lung (obtained from left chest in the third intercostal space at mid-clavicular line) (13). Available online: http://www.asvide.com/articles/674
Figure 8
Figure 8
The clip shows the absence of lung sliding and pulsing, replaced by multiple A-lines (obtained from right chest in the third intercostal space at mid-clavicular line) (14). Lung sliding should be distinguished from respiratory effort causing movement of the chest wall as shown in this video clip. Note there is no relative movement between visceral and parietal pleura. Available online: http://www.asvide.com/articles/675
Figure 9
Figure 9
Lung point identified at the junction where visceral and parietal pleura contact with each other (16). On the left side at the pleural line there is no lung sliding and the underlying field is filled with A-lines. On the right side there is evident lung sliding with b lines (it appears like lasers emitting from one point with multi-beam function switched on). Available online: http://www.asvide.com/articles/676
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