This document provides an overview of lung ultrasound and discusses various lung pathologies that can be identified using ultrasound. It begins with background on lung anatomy and ultrasound principles. Various normal and abnormal findings are then described, including pneumothorax, pulmonary edema, consolidation, pleural effusions, and lung tumors. Case studies are presented to demonstrate ultrasound identification of conditions like emphysema, pneumonia, pulmonary edema, pneumothorax, and lung cancer. The document emphasizes that lung ultrasound allows accurate diagnosis of many lung conditions at the point of care based on visualization of artifacts, B-lines, lung sliding, and consolidations.

1. Lung Ultrasound
James Rippey

2. The Key Message
Think & Understand
Anatomy & Physiology
Pathology
Clinical suspicion
Ultrasound

3. Understanding Air Ultrasound
Air reflects all ultrasound – mirror like
The appearance depends on the interface
Surfaces
Angles
Size
Movement

4. Lung Ultrasound is about Artefacts
• Artefacts at the pleural surface
• Focus on pleural surface
• Turn smoothing algorithms off
–Compound imaging
–Tissue Harmonics

5. Normal lung and pleura

8. Pneumothorax

12. Pneumothorax

14. Science Experiment 1
• Make a model of:
–Pneumothorax
–Normal lung
–Lung point

15. Normal lung and pleura
Factors changing the pleural surface or lung sliding.
Asthma, COPD, non-ventilation, sticky lung, pleurodesis

16. Emphysema

18. Subcutaneous emphysema

19. CT COPD with Bullae

20. Normal lung and pleura

21. Pulmonary oedema

22. Pulmonary oedema

24. The B-Line

25. Pulmonary oedema
B-lines – pulmonary oedema, pneumonitis, contusion,
early pneumonia, fibrosis, deep to other pathology

26. Fibrosis

27. Science Experiment 1
• Make a model of:
–B-lines

28. Normal lung

29. Consolidation
Solid lungs: Hepatisation, air bronchograms,
Atelectasis (compression / resorption), haemorrhage, tumour, infarction

30. Consolidation

32. Science Experiment 1
• Make a model of:
–Consolidation
–?Air bronchogram

34. Pleural effusion
Size, anechoic or echogenic, loculated, solid nodules,
pleural thickening, compressive atelectasis

35. Size, anechoic or echogenic, loculated, solid nodules,
pleural thickening, compressive atelectasis

36. Science Experiment 1
• Make a model of:
–Pleural effusion
–Empyema
–Atelectatic lung

37. Lung Ultrasound
Clinical reasoning
Understanding pathology
Ultrasound
Integrate clinically

38. Let’s Go and Scan!

39. Case Study 1
• Elderly life long smoker
• Presents with increasing shortness of breath
• A little chest discomfort

41. • There is a reduction in the normal lung
markings, however at one point a comet tail
artefact is seen
• There is lung sliding

43. • There is no lung sliding seen, and no
interstitial lung markings are evident
• The appearance is that of pneumothorax

44. Severe emphysema with apical bullae

45. Case study 2
• Young man with history of sarcoma
• Increasing shortness of breath

48. • Large pleural effusion
• Fine echogenic debris suggests exudate,
infection or blood
• Nodules on pleural surfaces suggest
malignancy
• Describe spine sign and descending aorta
visualisation

49. • Consolidation
• Hepatisation, air bronchograms, shred sign

50. Case Study 3
• Fevers, cough, widespread aches and pains,
bed bound for several days.
• Increasing shortness of breath
• Worse today with chest pain

52. Subcutanous emphysema
• There is air lying between the facial planes
• No ribs are seen
• This is surgical emphysema obscuring true
interpretation of the underlying lung

54. Pneumomediastinum
• Here the carotid and IJ are briefly seen, with
surrounding air in the soft tissues

59. Ultrasound Findings
• Surgical emphysema
• Small pneumothorax
• Widespread patchy consolidation
• H1N1 pneumonitis

60. Chest X-ray

61. CT Scan - H1N1 Influenza

62. Pneumomediastinum

63. Case study 4
• Young woman, cough, fever, shortness of
breath

66. • Similar appearance widespread
• Viral pneumonitis
• C profile

67. Case Study 5
• Acute onset shortness of breath

74. • Multiple bilateral B-lines
• Small bilateral pleural effusions
• Echo to assess LV function
• Likely acute pulmonary oedema

75. Case study 6
• Middle aged male presents with increasing
shortness of breath on returning from Africa

81. • Multiple lung metastases

82. Case study 7
• Alcoholic, poor state of health
• Fever, weight loss

83. From Saksham Gupta

84. • Empyema

85. Case Study 8
• Cough and pleuritic chest pain

88. Case study 9
• Increasing shortness of breath and
haemoptysis

90. • Huge solid thoracic tumour

91. Case study 10
• Pleuritic chest pain and short of breath

93. • Consolidation, air bronchogram, shred sign

94. Case study 11
• Young woman
• Recent flight
• Increasing shortness of breath

96. • This is a rib, you are on the long axis, it may
look like a pneumothorax

98. • This is sliding the transducer off the rib onto a
pleural space

101. • Hydropneumothorax

103. Case Study 12
• Direct chest trauma to right anterior chest
wall

105. • Remainder of lung fields demonstrated
normal sliding and artefacts
• Localised B-lines at site of trauma
• Pulmonary contusion

106. Case study 13
• History COPD
• Chest trauma and shortness of breath

108. • Surgical emphysema

112. • Tension pneumothorax on CT

114. • ICC inserted
• Next day increasing shortness of breath

116. • CXR shows mediastinal shift
• ?New tension – ICC still in
• ?Collapse

119. • Solid lung, collapse confirmed with ultrasound

122. • Post chest physio - recovery

123. Case study 14
• A few more pneumothoraces and lung points!