CARDIAC ULTRASOUND Earlier we mentioned that all the valves of the heart have three leaflets, EXCEPT one – the mitral. The mitral valve has 2 leaflets. You can tell these 2 leaflets apart on ultrasound… the ANTERIOR leaflet will be the one closest to the interventricular septum (the septum between the 2 ventricles). The posterior one will be closer to the posterior septum.
2. Pneumothorax = air in the pleural space
between the lungs and the chest wall
Interstitial Edema in the Lungs = fluid in the
lung tissue, often due to heart failure
Pleural Effusion = fluid accumulation in the
pleural cavity.
Pneumonia: fluid in the alveoli, often infected.
Why use pulmonary ultrasound?
8. Where is the VPPI?
Normal:
VPPI
sliding back
and forth
9. M mode
• M mode = Motion mode
• Can be used to see sliding of lungs
at the VPPI
• Normal: Grainy lines = motion at
VPPI
• Pathology: Horizontal lines = no
motion
14. Summary
• Pneumothorax= collapsed lung
• When patient is supine, check for
pneumothorax on anterior zones of the
chest because air rises
• 2nd intercostal space, sagittal indicator
direction → M Mode
• Sky-ocean-beach indicates motion
• Barcode sign indicates no motion →
pneumothorax
15. Artifacts
• Appear on image, but not in body
• Due to how the sound waves travel through
certain structures
• 3 artifacts in Pulmonary Ultrasound:
curvilinear or phased array probes are best,
can use linear
• A lines, B lines
• Mirror image artifact
16. A Lines
• Sound waves scatter when they
reach the air in lungs
• A Lines = horizontal
• A= Air Artifact
• A lines are seen in NORMAL
patients
20. B lines
• Seen when FLUID replaces AIR in the lungs
(interstitial edema in the lungs)
• Hyperechoic, VERTICAL artifacts that erase
A lines
• Normal: 0-4 B lines
• Pathology: Multiple diffuse B lines
suggests interstitial or alveolar fluid
(interstitial edema)
21. B lines = Fluid Replaces Air
VERTICAL
RAYS OF
SUNSHINE
ABNORMAL
23. B lines replace A lines
Abnormal Normal
Which image shows a normal lung?
24. Summary: diagnosing
interstitial edema
Probe: use a deep probe such as curvilinear or phased array.
Orientation: sagittal (generally
Normal
A lines: HORIZONTAL
B lines: occasional after prolonged inactivity
Pathology
B lines: >4 suggests interstitial edema
25. What are HORIZONTAL
reverberation artifacts called in
the lungs?
A lines
What are VERTICAL
hyperechoic artifacts called in
the lungs?
B lines
29. What do B lines indicate?
Interstitial edema
(Fluid in the lung
alveoli)
30. Pleural effusion =
fluid in pleural cavity
Orientation: coronal
at mid axillary line
Probe: phased array
or curvilinear
Assessing for Pleural Effusion
35. Which probe is used for
pneumothorax?
Linear
Which probe is used for pleural
effusion?
Phased array or curvilinear
36. Pneumonia
Pneumonia presents often as fever, tachypnea, cough
and abnormal lung sounds. On ultrasound you can find:
• Patchy B lines
• Findings of consolidation including hepatization and
echogenic lung.
• Small or tiny pelural effusion
• Associated signs of sepsis are often present, with
hyper dynamic heart and small inferior vena cava.
• “Spine sign” indicating abnormal lung at the bases.
37. Scanning Lung Zones
These are a good way to
scan the whole lung
looking for pneumonia.
Use the curvilinear or
phased array probe.
41. Lung summary
• Ultrasound is useful to diagnose pleural effusion,
pulmonary edema, pneumothorax and pneumonia.
• Practice today will include:
• Right and left upper quadrant to visualize diaphragm
and spine shadows
• Use of linear probe to visualize VPPI to evaluate for
pneumothorax, including M mode
• Scanning of anterior lung to identify A lines
• Scanning lung zones to look for pneumonia
