Ultrasound Case 002

Presentation

35 year old male represents with shortness of breath 5 days after falling of his bicycle. His initial chest x-ray on day one had shown a tiny pneumothorax and several rib fractures.

Left Chest: Upper anterior

Left Chest: Upper anterior
View 2 – Right Chest: Upper anterior
Right Chest: Upper anterior

View 3 – Left Chest: Posterolateral
Left Chest: Posterolateral
View 4 – Left Chest: Posterolateral
Left Chest: Posterolateral
View 5 – Left Chest: Posterolateral
Left Chest: Posterolateral

Describe and interpret these scans

IMAGE INTERPRETATION

Image 1: Pneumothorax with loss of lung sliding and loss of short path reverberation artefacts (comet tail and B-lines)

Image 2: Normal lung sliding and comet tail artefact on the asymptomatic side.

Image 3: Pleural effusion with underlying collapsed lung

Image 4: Pleural effusion with collapsed lung, but now an air fluid level is seen descending on inspiration.

Image 5: Linear transducer shows the curved diaphragm moving with inspiration. There is an air fluid level of the haemopneumothorax.


CLINICAL CORRELATION

Haemopneumothorax

A pneumothorax is rapidly detected, as is the basal pleural effusion.

The air fluid level is often confused with a lung point, but rather than the dynamic point of separation between the parietal and visceral pleural surfaces that is the lung point, this is the site of the junction between air and fluid in a hydropneumothorax.

Dependent fluid with air above it. The collapsed lung can be seen through the pleural fluid.

Haemopneumothorax

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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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