Clinical Indication

Dyspnea, chest pain, cough, hypoxia, tachypnea, abnormal lung sounds, penetrating trauma

Probe Selection

Linear, Curvilinear or Cardiac

Tips and Pathology

  • Thoracic ultrasound is incredibly useful in undifferentiated dyspnea, it can drastically change your management (i.e. COPD vs. CHF exacerbation) and provide useful information in a patient who is unstable or unable to tolerate lying flat for CT.  Lung ultrasound relies heavily on the presence of artifacts (A-lines, B-lines, etc), choose the "Lung" exam if there's an option, or the "THI" button to allow for artifacts to be seen.  
  • DEPTH: with the exception of PTX evaluation, your depth should be set to at least 12-15 cm to avoid missing deeper pathology.  The inferior thorax views (R4/L4) need to visualize the diaphragm.
  • Pneumonia - "shred sign" or focal B-lines
  • Pleural Effusions/Hemothorax - "spine sign" when you can visualize the thoracic vertebrae above the diaphragm, indicating fluid within the pleural cavity
    • For more on estimating volume, click here
  • Pulmonary Edema - look for pathologic B-lines (> 3/intercostal space)
  • Pneumothorax:  Start apically in the mid-clavicular line in an upright patient (L1/R1).  Evaluate for normal lung sliding using Motion Mode (M-mode) to look for the movement of the visceral and parietal pleural as they slide past one another with respiration.
    • Normal: "seashore sign" = sand (lung parenchymya), water's edge (pleura), sea (muscle), and sky (subQ)
    • PTX: "bar-code sign" = vertically stacked horizontal lines due to the lack of motion
      • "lung point sign" = normal lung can be seen transitioning into PTX, helpful for estimating size/extent of PTX and highly specific