Once thought to be impossible, lung ultrasound, heavy on the nuanced interpretation of sonographic artifacts as well as direct insonation of pathologic lung and surrounding structures was shown to be quite achievable by the father of lung ultrasound, Daniel Lichtenstein. We now use ultrasound diagnostically to diagnose lung congestion from heart failure, ards, pleural effusion, pneumonia, pneumothorax, pulmonary infarct. In addition, lung/thoracic ultrasound can be used to reduce complications from thoracostomy and to provide a guardrail in volume resuscitation. Closely related is airway ultrasound, including evaluation of endotracheal tube placement and preparation for cricothyroidotomy. Airway US is covered on its own page at nwhed.org.
INDICATIONS
- Acute Dyspnea of unclear etiology
- Evaluation for specific processes:
- Acute Interstitial Syndrome
- Pleural Effusion
- Pneumonia
- Pneumothorax
- Anatomic Scan in preparation for thoracostomy
PREPARATION
A wide array of probes can be used in thoracic ultrasound and they each have strengths and weaknesses.
The phased array probe (center) has a small footprint and can image nicely between ribs. It has fairly deep penetration and is a good choice for general thoracic imaging.
The linear probe affords high resolution views of proximal structures like the pleural line. This is helpful, for example, in assessing whether your patient with acute interstitial syndrome (lots of b-lines in multiple lung fields) is more likely to have pulmonary edema from heart failure or ARDS (acute respiratory distress syndrome).
The large curvilinear probe can also to quickly add thoracic imaging to your abdominal exam – for example, in trauma.
VIEWS
- Anterior Upper Chest Wall
- Lateral Chest Wall
- Posterior Inferior Chest Wall
PATHOLOGY
Acute Interstitial Syndrome
Pleural Effusion
Pneumonia
Pneumothorax
Thoracostomy Preparation
RESOURCES AND REFERENCES
- ACEP Sonoguide
- 5 Minute Sono Lung ultrasound videos