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Point of Care Lung Ultrasound
Sudhir Datar, M.D.,
Department of Neurology,
Neurocritical care,
Wake Forest Baptist Health.
• I have no relevant financial disclosures
Objectives
• Introduction to point of care pulmonary ultrasound
• Indications
• Use of lung ultrasound in clinical decision making
• Pleural effusion, pulmonary edema, pneumothorax
Case study
• 65 year old woman with history of CHF with EF 25%,
COPD with 60 pack year smoking history and history of
lung fibrosis from chronic use of amiodarone
• Presents with shortness of breath to the ER
• CHF exacerbation vs COPD exacerbation vs CAP or a
combination of these?
Advantages
• Better portability
• Real time imaging
• Guidance during procedures
• Differentiating effusion from infiltrates
• Early detection of procedure related complications such as pneumothorax
• Absence of radiation
Disadvantages
• Operator dependent
• Needs expertise and training
• Less informative than CT scan for certain complex pleural
and parenchymal pathology
• Not better than CT for interventional procedures
Indications
• Bedside detection of pleural effusion
• Early detection of pneumothorax following central line
placement
• Guidance for thoracentesis
• Differentiating between pleural masses/thickening vs
pleural fluid
Ultrasound Basics
• Lower frequency = more penetration but at the cost of less
resolution
• Higher frequency = less penetration with greater resolution
Probes
Curvilinear probe- 2-5 MHz Linear probe- 5-10 MHz
Lung Ultrasound Approach
Current Cardiology Reviews, 2012, 8, 123-136
Approach to lung USG
Approach to lung USG
Normal lung
(Artifacts)
Longitudinal position
Pleural lineRibArtifacts
A line
artifact
Normal lung (Artifacts)
Liver
Mirror Image
Abdominal Approach
The mirror sometimes does lie
A lines
A lines
B lines
Lung sliding
Pneumothorax
• 176 blunt trauma patients
• Prospective study
• CXR sensitivity 75%, specificity 100%
• Ultrasound sensitivity 98%, specificity 99%
Blaivas, et al. AEM 2005; 12.
Pneumothorax
Pneumothorax
• Sliding can be absent in
• Advanced COPD
• Pleural adhesions
• Pleural effusion
• Chest tubes
Lung point
Lung point
Pneumothorax M-Mode
Seashore sign Barcode sign
Pleural Effusion
Pleural effusion
Spleen
Lung
Effusion
Pleural effusion
