POCUS is a valuable and sensitive tool for the assessment of a pneumothorax. Recall that a pneumothorax occurs when air collects in the pleural space, causing the lung to partially or completely collapse.
On POCUS, the key is to assess the pleural line where normal lung movement (lung sliding) should be visible during respiration
Ultrasound Setup
Probe(s): Curvilinear or Phased array
Preset: Lung or abdominal
Position: Position the patient upright, if possible.
No pneumothorax is seen in this video.
Steps for Image Acquisition:
Probe Placement: Place on the most anterior part of the chest. In supine patients, air rises so the pneumothorax is most easily detected anteriorly
Visualize the Pleura: Adjust depth to visualize the pleural line just beneath the ribs
Assess for Lung Sliding: Observe the pleural line for lung sliding during respiration
Scan Multiple Zones: Assess for lung sliding in 3 locations per hemithorax. Move progressively down the chest to examine additional zones, including lateral areas
Optional: Use M-Mode to further assess:
Normallung will show a seashore sign.
Pneumothorax will demonstrate a barcode sign
Findings Suggestive of Pneumothorax
Findings Suggestive of Pneumothorax
Findings Suggestive of Pneumothorax
Absent lung sliding: No pleural line motion ⚠️ Not specific to a pneumothorax
Lung point: Transition where the collapsed lung contacts the chest wall, highly specific for pneumothorax
Findings that Rule out Pneumothorax
Findings Suggestive of Pneumothorax
Findings Suggestive of Pneumothorax
Presence of lung sliding: Indicates the visceral and parietal pleura are in contact, ruling out pneumothorax at that area
Presence of B-lines: Vertical artifacts arising from the pleural line, excluding pneumothorax at that area