2. +
A shot in the dark…
simply a hopeful
attempt to hit an enemy
that you can't see
3. +
Why Use Thoracic Ultrasound?
Increasingly “standard
Stop “shooting
of care” issue
in the dark”
Both for Seldinger and conventional “surgical” drains
Really
informative – negative findings also important
Interesting
Enjoyable!
and challenging
4. + Objectives
Level 1 sono-anatomy
Right and left hemidiaphragm
Ribs and intercostal spaces
Lungs
Heart
Liver, spleen, kidneys
5. +
Diaphragm
Double
Easily
or triple line
seen in presence of effusion from mid-axillary line
Abdominal
surface visible with ascites
Curves
upwards except with large effusions
Closely
applied to liver/spleen – used as acoustic windows
Functional
assessment feasible
14. +
Lungs – normal static findings
Normal
lung considered “invisible” to ultrasonographer
Artefacts
A
can be used to infer normality or abnormality
lines
horizontal reverberation artifacts from pleural line
the only finding in 2/3 of normal lung US
B
lines
vertical narrow bands from pleural line to edge of screen
obliterate the A line
multiple B lines = Ultrasound Lung Rockets = interstitial oedema
Abnormal
lung has characteristics that are clinically useful
15. +
Lungs – normal static findings
Rib
Rib
Rib
A lines
B line
Wipe out A lines as they pass
“Bat sign”
16. +
Lungs – normal dynamic findings 1
Pleural
sliding (lung sliding sign)
Pleural
line “shimmers” with respiration
Presence
Lung
sliding greatest in lower thorax (greatest expansion)
Absence
of lung sliding rules out pneumothorax
of lung sliding has a number of causes
Pneumothorax
Apnoea
Pleural adhesions
Mainstem bronchial intubation or occlusion
Critical parenchymal lung disease e.g. ARDS, contusion
18. +
Lungs – normal dynamic findings 2
M-mode “seashore sign”
Structures superficial to pleural line are static
= Horizontal lines on M-mode (motion against time) = WAVES
Motion of pleural line is “reflected” deep to it
= Granular pattern reflecting motion = SAND
19. +
M-Mode seashore sign
Static structures
horizontal lines (waves)
Pleural line
Pleural line reverberations
dynamic – granular (sand)
20. +
Lungs – normal dynamic findings 3
“Lung
pulse” sign
Cardiac
pulsations transmitted via lung to pleura
When
seen in the absence of sliding…
Normal if breath-hold
Abnormal in other conditions with no sliding
Presence
of lung pulse excludes pneumothorax
36. +
Lung consolidation
Tissue pattern
Boundary or shred line
ragged boundary between consolidated and normal lung
Air bronchograms
loss of air barrier leading to a “real” tissue image akin to liver i.e.
hepatisation
Non-mobile linear or punctate hyper-echoic features
Fluid bronchograms
May be partially fluid-filled with material motion visible with breathing
44. +
Pneumothorax – lung point sign
1) Transient normal
pattern as lung
reaches chest wall
at peak inflation or
2) transition zone
where lung is sitting
on chest wall