Pleural ultrasound has several advantages over other imaging techniques including immediate bedside availability, repeatability, rapid application, lower cost, and reduced radiation exposure. There are specific scanning positions and techniques used to visualize the diaphragm, quantify pleural fluid volume, and identify sonographic signs of pleural fluid and pneumothorax. Pleural fluid volume can be estimated using the distance between the pleural layers or by calculating the sum of distances multiplied by 70 for sitting patients. Key signs of pneumothorax on ultrasound include absent lung sliding, exaggerated horizontal artifacts, and loss of lung impulse.

2. Pleural Ulrasound
Gamal Rabie Agmy ,MD ,FCCP
Professor of Chest Diseases, Assiut University

4. • Immediate bedside availability
• Immediate bedside repeatability
• Rapid goal directed application
• Cost saving
• Reduction in radiation exposure
Advantages of Transthoracic
Ultrasonography

6. Scanning Positions for
Chest Sonography

15. 1-Frequently very high in the supine
critically ill patient
2-Particular caution in post CABG
patients -unilateral diaphragmatic
dysfunction may confuse the examiner
3-Massive edema and obesity may
degrade image quality
Diaphragm

19. *The amount of pleural fluid can be
estimated by the following formula:
V (ml)= 20 x Sep
V = volume, Sep = maximal distance
between the two pleura layers.
*For sitting patients a good method is to
calculate the sum of the basal lung to
diaphragm distance and the lateral height
of the effusion and to multiply the sum by
70.
Quantification of Pleural Fluid:

20. Sonographic signs of pleural fluid
1. Echo-free zone separating the visceral and
parietal pleura
2. Echo-free zone displaying a change of form
during breathing
3. Floating and moving echogenic particles
4. Moving septations within the pleural space
5. Moving lung within the fluid
6. “Fluid color” sign – on Doppler sonography

25. the "seashore sign" (Fig.3).

27. Absent lung sliding
Exaggerated horizontal artifacts
Loss of comet-tail artifacts
Broadening of the pleural line to a band
Lung point
Loss of lung impulse
The key sonographic signs of
Pneumothorax