Best Practice Case Studies-Pulmonary Edema UC

Video Transcription

Hi, I am Kathy Vidlock from Rocky Vista University, and I'm going to do an ultrasound consult on this case of pulmonary edema.  Doing a full lung ultrasound is really beyond the scope of what we're going to go over in  this quick case, but you would use a curvilinear transducer or potentially a linear, especially in some of the places where you can more superficially see the lung.  You're going to look in the midclavicular line, the midaxillary line, and the posterior axillary line. This is an image of a normal lung ultrasound.  So you're going to basically look in between the ribs here, and we're going to talk today about A lines and B lines.  A lines are simply artifacts that happen when the ultrasound beam is hitting the alveoli, and these are horizontal lines that you will see usually equidistance from each other,  and this is just a reverberation artifact. Artifacts help us a ton in lung ultrasound. Here's another image of a normal lung ultrasound, and this is in M mode, and again on the left  you can see the image. We're looking in between the two ribs, and you get this picture in M mode that looks  kind of like a horizon on a seashore, and that horizon part of it will be the skin and subcuticular tissue.  Then you'll see the area that looks like water, and that is a muscle layer, and then the next area looks like sand, and that is really more of the lung space.  Again this is what a normal lung in M mode looks like. So what happens when we are ultrasounding the lung with pulmonary edema?  Well here we have another artifact that can be really helpful to us, and that's called B lines. B lines are vertical, A lines are horizontal, that's one thing to remember.  So when you get your transducer lined up in between two ribs, you will see these vertical lines which are simply short reverberation artifacts that are happening due to fluid  within the interlobar space, which happens in pulmonary edema and some other conditions. So that is why they're present.  If you are a novice to this, it can almost look like is there a rib space there, what's  you have to line it up so you are in between two ribs, and then look for the B lines specifically within that space. Thank you.

Video Summary

Kathy Vidlock from Rocky Vista University provides a brief overview of using ultrasound to assess pulmonary edema. For lung ultrasounds, a curvilinear or linear transducer is used to examine the midclavicular, midaxillary, and posterior axillary lines. Normal lung ultrasounds show A lines, horizontal artifacts from alveoli, and in M mode, resemble a horizon landscape. In cases of pulmonary edema, B lines, vertical artifacts indicating fluid in the interlobar space, become visible. Aligning the transducer between ribs helps identify these lines, which are critical in diagnosing conditions like pulmonary edema.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 33

Topic Lung

Keywords

3rd Edition, CASE 33

3rd Edition

Lung

ultrasound

pulmonary edema

transducer

A lines

B lines