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Signs and lines in lung ultrasound

Rohit Bhoil
Rohit Bhoil
, 
Ajay Ahluwalia
Ajay Ahluwalia
, 
Rajesh Chopra
Rajesh Chopra
, 
Mukesh Surya
Mukesh Surya
 und 
Sabina Bhoil
Sabina Bhoil
   | 09. Sept. 2021
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Article Category: research-article
Online veröffentlicht: 09. Sept. 2021
Seitenbereich: 225 - 233
Eingereicht: 03. Juni 2020
Akzeptiert: 18. Aug. 2020
DOI: https://doi.org/10.15557/jou.2021.0036
Schlüsselwörter
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

Lung ultrasound examination sites. Both hands are placed, side by side, on the anterior chest wall (as shown); the little finger of the upper hand rests along the lower border of clavicle.(position of the thumbs are not considered). The area covered by the hands, corresponds to the location of the underlying lung. When placed this way, the little finger of the lower hand aligns with the phrenic line or the lower border of the lung. This method defines three standardised points: (i) The upper BLUE-point is at the middle of the upper hand; (ii) The lower-BLUE-point is at the middle of the lower hand and the (iii) The PLAPS-point (posterolateral alveolar or pleural syndromes), which is indicated by the intersection of a horizontal line at the level of the lower BLUE-point and a vertical line at the posterior axillary line. However, the probe should be moved as posteriorly as possible, along this line to get more information in supine patients. The PLAPS point is located slightly above the level of the diaphragm
Lung ultrasound examination sites. Both hands are placed, side by side, on the anterior chest wall (as shown); the little finger of the upper hand rests along the lower border of clavicle.(position of the thumbs are not considered). The area covered by the hands, corresponds to the location of the underlying lung. When placed this way, the little finger of the lower hand aligns with the phrenic line or the lower border of the lung. This method defines three standardised points: (i) The upper BLUE-point is at the middle of the upper hand; (ii) The lower-BLUE-point is at the middle of the lower hand and the (iii) The PLAPS-point (posterolateral alveolar or pleural syndromes), which is indicated by the intersection of a horizontal line at the level of the lower BLUE-point and a vertical line at the posterior axillary line. However, the probe should be moved as posteriorly as possible, along this line to get more information in supine patients. The PLAPS point is located slightly above the level of the diaphragm

Fig. 2.

A. Grey scale ultrasound image showing the longitudinal scan of the intercostal space depicting the bat sign; B. Labelled view; Ribs and pleural line are outlined in white, arrows point to rib shadows
A. Grey scale ultrasound image showing the longitudinal scan of the intercostal space depicting the bat sign; B. Labelled view; Ribs and pleural line are outlined in white, arrows point to rib shadows

Fig. 3.

Grey scale longitudinal ultrasound scan of the intercostal space using high-frequency linear transducer (7–12 MHz) depicting A-lines
Grey scale longitudinal ultrasound scan of the intercostal space using high-frequency linear transducer (7–12 MHz) depicting A-lines

Fig. 4.

Grey scale ultrasound image depicting the curtain sign – the aerated lung in the costophrenic recess overlaps part of liver and diaphragm creating a demarcated leading edge of the lung air artefact, giving the appearance of curtain (of air). Both images are in different part of the respiratory cycle. CS – curtain sign; L – liver; D – diaphragm
Grey scale ultrasound image depicting the curtain sign – the aerated lung in the costophrenic recess overlaps part of liver and diaphragm creating a demarcated leading edge of the lung air artefact, giving the appearance of curtain (of air). Both images are in different part of the respiratory cycle. CS – curtain sign; L – liver; D – diaphragm

Fig. 5.

A. Grey scale longitudinal ultrasound scan of the intercostal space depicting the Pleural line-P (arrow; stars indicate the rib shadows); B. Power Doppler image of normal sliding lung. The presence of colour indicates movement at the pleural line
A. Grey scale longitudinal ultrasound scan of the intercostal space depicting the Pleural line-P (arrow; stars indicate the rib shadows); B. Power Doppler image of normal sliding lung. The presence of colour indicates movement at the pleural line

Fig. 6.

A. M-mode ultrasound image depicting the sea-shore sign; P indicates the pleural line; B. The stratosphere/barcode sign in which no movement is seen below the pleural line
A. M-mode ultrasound image depicting the sea-shore sign; P indicates the pleural line; B. The stratosphere/barcode sign in which no movement is seen below the pleural line

Fig. 7.

A. Grey scale longitudinal ultrasound scan of the intercostal space depicting the vertically coursing B-lines (arrows); B. Confluent B-lines (arrows) are seen. The B-lines obscure the horizontal A-lines which are seen in the adjacent intercostal space (depicted by asterisk)
A. Grey scale longitudinal ultrasound scan of the intercostal space depicting the vertically coursing B-lines (arrows); B. Confluent B-lines (arrows) are seen. The B-lines obscure the horizontal A-lines which are seen in the adjacent intercostal space (depicted by asterisk)

Fig. 8.

A. Grey scale longitudinal ultrasound scan of the intercostal space depicting the quad sign. The area of pleural effusion is framed within four regular borders: the pleural line-P, the shadow of the ribs (stars), and the almost regular deep border, which is the lung line-L; B. M--mode image of pleural effusion depicting the sinusoid sign
A. Grey scale longitudinal ultrasound scan of the intercostal space depicting the quad sign. The area of pleural effusion is framed within four regular borders: the pleural line-P, the shadow of the ribs (stars), and the almost regular deep border, which is the lung line-L; B. M--mode image of pleural effusion depicting the sinusoid sign

Fig. 9.

Grey scale longitudinal ultrasound scan of the intercostal space showing collapsed lung (arrow) which appears as moving jellyfish on real time sonography. L – liver; PLEF – pleural effusion
Grey scale longitudinal ultrasound scan of the intercostal space showing collapsed lung (arrow) which appears as moving jellyfish on real time sonography. L – liver; PLEF – pleural effusion

Fig. 10.

Grey scale longitudinal ultrasound scan of the intercostal space showing multiple punctuate foci representing floating debris – the plankton sign. L – liver; PLEF – pleural effusion
Grey scale longitudinal ultrasound scan of the intercostal space showing multiple punctuate foci representing floating debris – the plankton sign. L – liver; PLEF – pleural effusion

Fig. 11.

Grey scale longitudinal ultrasound scan of the intercostal space depicting the visualisation of vertebral bodies above the diaphragm in a case of pleural effusion (A and B). The vertebral bodies are not normally seen above the level of the diaphragm (C); L – liver; K – kidney; PLEF – pleural effusion
Grey scale longitudinal ultrasound scan of the intercostal space depicting the visualisation of vertebral bodies above the diaphragm in a case of pleural effusion (A and B). The vertebral bodies are not normally seen above the level of the diaphragm (C); L – liver; K – kidney; PLEF – pleural effusion

Fig. 12.

Grey scale ultrasound image depicting the tissue sign with consolidated lung visualised directly beneath the pleura. Multiple B-lines are also seen (arrows)
Grey scale ultrasound image depicting the tissue sign with consolidated lung visualised directly beneath the pleura. Multiple B-lines are also seen (arrows)

Fig. 13.

Grey scale longitudinal ultrasound scan of the lung using a high-frequency linear transducer (7–12 MHz), depicting the ‘double lung point’ sign in an infant with TTN. Compact B--lines due to interstitial oedema are seen in the lower lung field
Grey scale longitudinal ultrasound scan of the lung using a high-frequency linear transducer (7–12 MHz), depicting the ‘double lung point’ sign in an infant with TTN. Compact B--lines due to interstitial oedema are seen in the lower lung field

Fig. 14.

M-mode ultrasound image depicting the sea-shore sign. Arrows indicate the position of T-lines
M-mode ultrasound image depicting the sea-shore sign. Arrows indicate the position of T-lines
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