Chapter 18 - Ultrasound Evaluation of the Pleura
Video 18-1. This video shows the typical anatomic boundaries that surround a hypoechoic pleural effusion. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 8th intercostal space in the right mid-axillary line.
Video 18-2. This video shows the typical anatomic boundaries that surround a hypoechoic pleural effusion. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 8th intercostal space in the right mid-axillary line.
Video 18-3. This video shows a pleural effusion with respirophasic and cardiophasic movement of atelectatic lung. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 7th intercostal space in the right mid-axillary line.
Video 18-4. This video shows a pleural effusion with respirophasic and cardiophasic movement of echogenic elements within the effusion. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 6th intercostal space in the left mid-axillary line.
Video 18-5. This video shows a pleural effusion, the diaphragm, and liver and the kidney. Definitive identification of the diaphragm is essential in order to localize a pleural effusion. This is required for safe thoracentesis, as inadvertent subdiaphragmatic device insertion is a potentially catastrophic complication of thoracentesis. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 9th intercostal space in the right mid-axillary line.
Video 18-6. This video shows a large pleural effusion and atelectatic lung. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 6th intercostal space in the right mid-axillary line.
Video 18-7. This shows a pleural effusion and mobile atelectatic lung. This is termed lung flapping or the jellyfish sign. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 7th intercostal space in the right mid-axillary line.
Video 18-8. This video shows a small pleural effusion and adjacent alveolar consolidation of the lung. With each inspiration, aerated lung is interposed into the imaging window with loss of visualization of the underlying structures. This is termed the curtain sign. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 8th intercostal space in the left mid-axillary line.
Video 18-9. This video shows a pleural effusion with respirophasic and cardiophasic movement of echogenic elements within the effusion. This is termed the plankton sign. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 7th intercostal space in the right mid-axillary line.
Video 18-10. This video shows a pleural effusion with respirophasic and cardiophasic movement of echogenic strands within the effusion. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 6th intercostal space in the left posterior axillary line.
Video 18-11. This video shows a pleural effusion with well-demarcated interface between an echogenic-dependent layer and an anechoic nondependent layer. This is termed the hematocrit sign, and is caused by gravitational effect on cellular components of the fluid. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 6th intercostal space in the left mid-axillary line.
Video 18-12. This video shows a swirling echogenic pleural effusion that is typical of an acute hemothorax. The diaphragm has a reverse curvature and there is a defect in the descending aorta consistent with traumatic laceration. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 8th intercostal space in the left posterior axillary line.
Video 18-13. This video shows a pleural effusion in which are multiple punctate echogenic foci that represent bubbles within the effusion. This was caused by an esophageal perforation. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 8th intercostal space in the left mid-axillary line.
Video 18-14. This video shows a multiseptated pleural effusion. This pattern is consistent with a complex parapneumonic effusion or empyema that will require fibrinolytic treatment or surgical drainage The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 8th intercostal space in the left mid-axillary line.
Video 18-15. This video shows a multiseptated pleural effusion. This pattern is consistent with a complex parapneumonic effusion or empyema that will require fibrinolytic treatment or surgical drainage. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 7th intercostal space in the left mid-axillary line.
Video 18-16. This video shows a pleural effusion with pleural masses caused by metastatic breast cancer. The 3.5 MHz transducer is in longitudinal orientation and placed perpendicular to the chest wall to scan through the 7th intercostal space in the left mid-axillary line.