Pneumonia Case 003

A 40 year old man presented with high fever, tachycardia and vomiting.

You search for a source of infection; this is his chest x-ray.

Chest XR LLL-pneumonia

You wonder whether the slight upper lobe infiltrate is consolidation and take a look with ultrasound. What do these clips of the upper left chest show?

Ultrasound View 1
Ultrasound View 2
Reveal Answer

These are both normal views.

The first is taken in the axilla and demonstrates normal lung sliding and a single B-line; perhaps from a trace of fluid in the fissure. This is a normal finding.

The second clip is taken on the posterior chest wall just medial to the scapula and is also normal.

The anterior view taken in the mid-clavicular line was almost identical, again normal.

These views show that there is no consolidation involving the ultrasound accessible pleural surfaces in the upper zones. It does not exclude upper zone consolidation that does not touch the pleural surfaces.

You then move to the posterior lower chest wall. What do these clips show?

Ultrasound View 3
Ultrasound View 4
Ultrasound View 5
Reveal Answer

These views demonstrate a patch of basal consolidation involving the left lower lobe.

The diaphragm is seen with the spleen lying below. The consolidated lung fills the costophrenic recess without associated effusion. There is patchy aeration and the irregular consolidation / aerated lung border – the shred sign – is seen.

On review the chest x-ray does show a patch of consolidation behind the left heart border.

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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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