Thread by @Pocus101

Confused about how to perform Lung 🫁 Ultrasound and all those Signs? Don't be!

1⃣Learn a Lung #POCUS Protocol
2⃣Learn all Common Lung US Signs
3⃣Learn all Major Lung US Pathologies

✅New Blog Post!
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#medtweetorial 👇 (1/24)

(2/) The parietal pleura interfaces with the visceral pleura, creating a sliding motion as we breathe.

Alveoli exist in lobules that are subdivided by interlobular septa. These areas can fill with fluid due to consolidation or pulmonary edema.

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(3/) Before scanning understand the surface anatomy of the lung!

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(4/) At our shop, we use a 6-point lung ultrasound protocol for general lung ultrasound. We expand this to 12 points if needed.

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(5/) Identify rib shadows and the "Batwing Sign"
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(6/) Identify Lung Sliding using B-Mode
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(7/) Evaluate for lung sliding using M-Mode by identifying the Seashore sign for the "sky, ocean, and beach."
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(8/) Identify A-lines by placing your probe perpendicular to the pleura.
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(9/) Evaluate the PLAPS point of the Right and Left lung.
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(10/) The curtain sign is seen in healthy and aerated lungs at PLAPS point. An aerated lung is like a “curtain” because as it fills with air, it looks like a curtain sweeping down and over the other organs, momentarily obscuring them from view.
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(11/) The mirror image artifact is a NORMAL finding in lung ultrasound
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(12/) Absent Lung Sliding with B-mode does not just mean PTX. It can ALSO be from:

pleurodesis
inflammation (ARDS)
severe COPD
Fibrotic lungs
Mainstem intubation

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(13/) Absent lung sliding with M-Mode (the Barcode or Stratosphere signs).
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(14/) To rule in PTX look for the Lung Point Sign
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(15/) For Pneumonias look for Dynamic Airbronchgrams within your consolidation.
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(16/) Finding it difficult to keep track of all the signs for pleural effusion? Don't worry, we got you covered:
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Spine Sign
Jellyfish sign
Quad Sign
Sinusoid Sign
Plankton Sign
Hematocrit Sign
Loculated Pleural Effusions

(17/) Spine Sign with spine extending past the diaphragm superiorly means there is a consolidation or pleural effusion present.
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(18/) The “Jellyfish Sign” occurs when a consolidated lung is seen floating in the pleural effusion.
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(19/) You can turn on M-mode to look for the Sinusoid sign (looks like a sine wave). It is caused by the parietal and visceral pleura moving closer and further apart while the patient breathes.
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(20/) A pleural effusion has an anechoic appearance often delineated by the pleural line, the rib shadows, and the lung line, called the “Quad Sign.”
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(21/) The plankton sign shows an effusion with swirling, hyperechoic debris.
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(22/) The hematocrit sign refers to the echogenic layering of material in a pleural effusion. This can be due to exudative effusions or a hemothorax.
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(23/) Here is an example of loculated pleural effusion
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(24/) Want more details on all of the major Lung Ultrasound Pathology Profiles? Check out the FULL blog post that goes over everything!
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Don't forget to check out the #POCUS clinical review book for a ton of Lung Ultrasound Cases!

Click here for a free preview of the book and an exclusive 20% discount: pocus101.com/RevBook