It is 8am and a 72 year old male is brought in by the paramedics. The patientt is sitting upright, sweaty, and in severe respiratory distress.
Observations: Afebrile, Pulse 120 regular; BP 180/90; O2 saturation 91% on Hudson mask.
What do the clips show?
- These views both show numerous B-lines.
- The changes are diffuse, symmetrical and bilateral.
- Pneumothorax, COPD and focal infection are far less likely now.
- Pulmonary oedema is the most common cause of this appearance.
- Pneumonitis, lymphangitis carcinomatosis and pulmonary fibrosis can also cause a similar appearance although these can usually be differentiated from the history and associated clinical features.
- Sonographic features including distribution of involvement, presence of pleural effusions and echocardiography are also invaluable in further assessment.
These views are taken bilaterally at the lung bases.
Describe the ultrasound findings
Bibasal small to moderate anechoic pleural effusions are present. The likelihood of pulmonary oedema of cardiac origin is more likely still.
An echo is performed. Views are poor as the patient is distressed and restless.
Describe the echo findings
This apical 5 chamber view shows very poor left ventricular function, particularly of the apex and interventricular septum again supporting the diagnosis of pulmonary oedema of cardiac origin.
Further views excluded severe valvular dysfunction.
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