The focused question: Can pneumothorax be confirmed or excluded?
Lung ultrasound is a valuable tool in diagnosing or excluding pneumothorax at the bedside. The key ultrasound signs to assess include lung sliding, lung pulse, B-lines, and the presence of a lung point. These signs will help determine whether a pneumothorax is present or can be excluded..
Ruling out pneumothorax: • The presence of lung sliding or a lung pulse on the anterior part of the thorax effectively rules out pneumothorax. • B-lines, representing vertical artifacts, also exclude pneumothorax when visualized on the anterior thorax.
Suspicion of possible pneumothorax: • The absence of lung sliding or lung pulse and the absence of B-lines on the anterior thorax raise suspicion of a possible pneumothorax.
Confirming Pneumothorax:
A definitive diagnosis of pneumothorax is made when there is no lung sliding, lung pulse, or B-lines on the anterior thorax, combined with the presence of a “lung point,” the transition point where the lung reattaches to the chest wall.
The clips below will demonstrate these ultrasound findings in various cases, helping you recognize the signs that confirm or exclude pneumothorax.
()
Top: Normal lung with sliding and B-lines present.
Bottom: No sliding, no lung pulse, and no B-lines — possible pneumothorax.
()
Five different clips showing the absence of lung sliding, lung pulse, and B-lines, indicating suspicion of pneumothorax.
()
Four different clips demonstrating normal lung signs, with visible lung sliding, lung pulse, and B-lines, effectively excluding pneumothorax.
()
Single clip showing normal lung signs with lung sliding and B-lines present, excluding pneumothorax.
()
Single clip showing normal lung signs with lung sliding and B-lines present, excluding pneumothorax.
()
Single clip showing normal lung signs with lung sliding and B-lines present, excluding pneumothorax.
()
Clip showing no lung sliding, no lung pulse, and no B-lines, indicating a possible pneumothorax.
()
Clip showing no lung sliding, no lung pulse, and no B-lines, indicating a possible pneumothorax.
()
Clip showing no lung sliding, no lung pulse, and no B-lines, indicating a possible pneumothorax.
()
Clip showing no lung sliding, no lung pulse, and no B-lines, indicating a possible pneumothorax.
()
Clip showing no lung sliding or pulse, with a small reverberation artifact resembling a comet tail or B-line. Findings suggest a possible pneumothorax, which could be confirmed by locating a lung point.
()
The lower part of the clip shows a CT cross-sectional illustration of the thorax with a pneumothorax on the patient’s right side (left side of the image). The collapsed lung lies at the bottom of the thoracic cavity. During inspiration, the lung partially expands, and during expiration, it retracts, symbolizing the movement of the lung in a pneumothorax. At the thoracic wall, the lung slides up and down. An ultrasound transducer is positioned over the area where the lung moves into the scanning plane during inspiration and out of it during expiration.
The upper part of the clip shows an ultrasound image demonstrating the “lung point.” An arrow indicates the lung point, which moves to the left during inspiration and to the right during expiration. The left side of the ultrasound clip shows no sliding, while the right side shows normal sliding, marking the transition between the pneumothorax and the aerated lung.
()
Ultrasound clip demonstrating a “lung point,” where the transition between pneumothorax and normal lung is visible.
A: The portion of the thorax where no lung is in contact with the thorax wall.
C: The area where the visceral and parietal pleura are in contact, showing normal lung sliding. B: The thorax wall.
()
Six ultrasound clips, each demonstrating the “lung point” in different patients with pneumothorax, showing the transition between the non-sliding area of the pneumothorax and the normal sliding lung.
()
Ultrasound clip showing a “lung point” with normal sliding visible on the left side and no sliding on the right side, indicating the boundary between pneumothorax and normal lung.
()
Another Ultrasound clip showing a “lung point” with normal sliding visible on the left side and no sliding on the right side, indicating the boundary between pneumothorax and normal lung.
