COPD Case 1 Lung Pulse

This patient has severe COPD and presents in extreme distress. An initial ultrasound is performed.

What does this clip show?

Reveal Answer

This clip demonstrates the sign known as lung pulse.

  • With severe hyperexpansion tidal volume is minimal and so lung sliding is markedly reduced.
  • Cardiac pulsation and the associated rhythmic mediastinal movement remain and are transmitted to lung.
  • Lung pulse confirms the absence of pneumothorax and alerts the clinician to poor ventilation.
  • The emphysematous lung creates a smoother more reflective pleural surface than normal lung. This means A-lines are more prominent.
  • Tidal volumes are smaller and lung sliding is subsequently less.

The patient improves slightly with non-invasive ventilation (BiPAP), but is there a pneumothorax on the other side?

Reveal Answer

This is an ultrasound of a patient with severe COPD; there is no pneumothorax.

Ultrasound appearance of COPD may be confused with pneumothorax for several reasons:

  1. The normal interstitial markings are fewer. It is the interstitial tissue that creates the slightly irregular lung surface, and the occasional B-lines and comet tail artefacts that characterise normal lung.
  2. The emphysematous lung creates a smoother more reflective pleural surface than normal lung. This means the horizontal reverberation artefact lines (A-lines) are more prominent.
  3. Tidal volumes are smaller and lung sliding is subsequently less.

What does this histological sample demonstrate?

Reveal Answer

This slide is a histological section of mildly emphysematous lung magnified 10 times.

Air-spaces are enlarged with loss of alveolar walls and pulmonary interstitial tissue.

This explains why in emphysema the ultrasound appearance is often more like pneumothorax than normal lung.


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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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