2. Chest space - the final frontier
• These are the voyages of the starship Ultrasound
• Its continuing mission:
– to explore strange new pictures
– to seek out life
– and new meanings
• To boldly go where only horse
has gone before
3.
4. Normal lung - no lung image
just artifacts
just artifacts
• Soft tissue/air interface 99% of ultrasound waves is reflected
• Lung is full of air if normal so ultrasound cannot be used to
image healthy lung, only the pleura
• But...
– with disease process lung loosing aeration
– less US beam reflection and more penetration
5. Normal lung = air
Reverberation artifact
Reverberation artifact
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A - line
pleural line
A - line
rib shadow rib shadow
6. Asthma lung - anterior
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A - line
Pleura
7. Normal - A profile - lung base
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Diaphragm
Liver
Lung
Spine
Curtain sign
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lung base
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spleen
left kidney
lung
lung
liver
right left
23. Ruling out pneumothorax after subclavian
line insertion
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Presence of pleural sliding or B-lines rules
out pneumothorax with 100% accuracy
pleural sliding
+
_
25. Differentiate basal lung
field opacities on
portable CXR
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28. 28
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Pneumonia - legionella
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detail
29. 51 post Tetralogy of Fallot repair acute
on chronic respiratory failure
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31. 31
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32. 74 yrs old lady - Nissen fundoplication
postoperative acute respiratory failure
33. 33
Perforated oesophagus
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34. Mediastinitis
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35. 21 yrs old boy - dyspnoea, can’t raise left arm
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37. 37
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38. Case
• 20 y old driver, multitrauma
–mild head injury
–rib fractures, lung contusions,
haemopneumothorax,
–liver laceration and ankle fractures
• One week in ICU, still intubated, febrile,
sudden desaturation, tachycardia,
hypotension, tachypnoea
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• Echocardiography demonstrates normal
LV and RV function and size
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Blunt chest trauma - sudden hypoxia.
Left lower lung collapse
Bronchoscopy - removal of thick sputum plug from left lower lobe bronchus
42. Failure to wean
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43. 43
H1N1 - ARDS - TOE
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46. Lung ultrasound is feasible
• Bedside, point of care test
• Quick, easy to repeat
• No radiation exposure
• Dynamic nature
– visualization of pleural/lung
interface during inspiration and
expiration
47. Lung ultrasound in ICU
• Often more useful then CXR
• Steep learning curve
• Provides quick answers to
simple clinical questions
arising from history and
clinical examination
• - in parallel