Unusual new signs of pneumothorax at lung ultrasound
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Volpicelli et al. Critical Ultrasound Journal 2013, 5:10 http://www.criticalultrasoundjournal.com/content/5/1/10
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Unusual new signs of pneumothorax at lung ultrasound Giovanni Volpicelli1*, Enrico Boero1, Valerio Stefanone1 and Enrico Storti2
Abstract Background: The diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology. The conventional lung ultrasound examination consists of a step-by-step procedure targeted towards the detection of four classic ultrasound signs, the lung sliding, the B lines, the lung point and the lung pulse. In most cases, a combination of these signs allows a safe diagnosis of pneumothorax. However, the widespread application of sonographic methodology in clinical practice has brought out unusual cases which raise new sonographic signs. The purpose of this article was to introduce some of these new signs that are described after the analysis of unusual and complex cases encountered during the clinical daily practice in an emergency department. Findings: The double lung point consists of the alternating patterns of sliding and non-sliding lung intermittently appearing at the two opposite sides of the scan. The septate pneumothorax allows B lines and lung pulse to be still visible in a condition of pneumothorax with absent sliding. In hydropneumothorax, the air/fluid border is imaged by lung ultrasound as the interposition between an anechoic space and a non-sliding A-pattern, a sign that may be named hydro-point. Conclusions: In bedside lung ultrasound, the operator should be aware and interpret double lung point, septate pneumothorax and hydro-point. The conventional diagnostic protocol of bedside lung ultrasound for pneumothorax should be occasionally adapted to such complex cases. Keywords: Emergency ultrasound; Critical ultrasound; Lung ultrasound; Pneumothorax
Findings Introduction
Lung ultrasound is nowadays acknowledged as a useful methodology for the diagnosis of pneumothorax at bedside [1]. The diagnostic value of the sonographic signs of pneumothorax is similar to the well-known and largely used radiologic signs of the same condition in chest radiography. Visualization of a gap between the parietal and visceral pleura in a chest film is largely used, and intuitively diagnostic of pneumothorax, even though, to our knowledge there are no published studies specifically designed to evaluate its specificity in comparison with a gold standard. Nevertheless, there is not any doubt about the power and high specificity of this radiologic sign of pneumothorax. Similarly, the sonographic signs of pneumothorax are largely intuitive of the condition and share the same very high specificity with the radiologic signs [2,3]. Absence of * Correspondence: [email protected] 1 Emergency Medicine, San Luigi Gonzaga University Hospital, Turin 10043, Italy Full list of author information is available at the end of the article
lung sliding or pulse and absence of B lines combined with a lung point during a lung ultrasound examination ha
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