Mount Sinai Emergency Medicine Ultrasound

Congratulations to Sinai’s own Dr. Jim Tsung, who recently coauthored a major evidence-based consensus guideline on point-of-care lung ultrasound. The manuscript is the result of a multi-national effort by pioneering clinician-sonographers, and was just published in the journal Intensive Care Medicine:

International evidence-based recommendations for point-of-care lung ultrasound.

PMID: 22392031

32 year old female with no past medical history presents with cough for two weeks, no fever, no sputum. Multiple sick contacts with same symptoms at work. She acutely presents with left rib pain for several days.  She reports no trauma, and noted the sharp, positional pain during a fit of coughing. Her vital signs are all within normal limits. She is breathing comfortably, with good air movement, no wheezes, rales, or ronchi. She displays point tenderness over her anterior left 8th rib at the anterior axillary line.  A chest x-ray was ordered; images are below.

Sonopalpation of the tender area revealed the following:

Untitled from Sinai EM Ultrasound on Vimeo.

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Thoracic ultrasound is one of the hottest topics in emergency and critical care sononography. Assessment for pneumothorax is accurate and relatively easy to learn.

One important sign when assessing for pneumothorax is the lung point. This is the point where normal pleural interface contacts the boundary of the pneumothorax. It is the most specific sign for pneumothorax using ultrasound.

Using B-mode ultrasound, the lung point will appear as the boundary between normal lung sliding and still lung.

Lung point:

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Data from the TRUST (Thoracic Rapid Ultrasound in Trauma) study was presented at the fifth EM Congress in Valencia, Spain on 9/17/2009. The project was selected as one of the top 50 abstracts at the conference. Special thanks to Danny Duque, Vicki Noble, and Betty Chang, our co-investigators on the study.

Bret presenting TRUST data