Mount Sinai Emergency Medicine Ultrasound

bringing technology to the bedside for improved patient care

Probe Selection:

Linear probe Linear array transducer

(Small parts/high frequency probe)

Probe Positioning:

When the patient is supine, scan along the anterior chest wall in a sagital (longitudinal) plane. Scan from the anterior axillary line to the lateral sternal border, from the 2nd rib towards the costal margin.
PTX probe position 1 PTX probe position 2

Normal Anatomy:

comet tail Rib shadows (R) are visible as bright reflectors with distal shadow.

The Pleura (* *) is a bright echogenic line beneath the ribs.

Comet Tail artifacts (> arrows) arise from normal pleura reflecting sound waves.

Using Video:

Normal Lung:

+Lung sliding back and forth

Note the pleura moves with respect to the ribs

+Comet tail artifacts

Pneumothorax:

NO lung sliding back and forth

Note the pleura and ribs move together

NO comet tail artifacts

Pleura-GIF PTX- GIF

Using M-Mode:

M-mode allows documentation of lung sliding with a single image. Superficial soft tissue/muscle does not move much during respirations, and will yield flat lines on M-mode (top half of images below). Normal lung sliding creates a grainy M-mode appearance (left image, bottom). This is referred to as “waves on a beach,” where the smooth soft tissue lines (top half) meet the rough lung lines (bottom half) at the bright white pleural line (center). With pneumothorax, lung sliding is absent- flat lines will be seen above and below the pleura.

Normal Lung:

Smooth lines above pleural line, grainy below

Pneumothorax:

Smooth lines above and below pleural line

Normal pleura Pneumothorax
Posted by Bret On January - 28 - 2008

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Image Databank

Right Diaphragmascites bowelVein tentingFem AVL comp +CFV DVT Longsubx2

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