Point of Care Lung Ultrasound Sudhir Datar, M.D., Department of Neurology, Neurocritical care, Wake Forest Baptist Health.
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