Point of Care Lung Ultrasound - Stages of Collapse and Consolidation A. NORMAL

Pulmonary Pathology and Associated Lung Ultrasound Findings Pneumothorax: - No lung sliding/barcode sign - Lung point (hard to find) - Bilateral A-lines (parietal pleura reflection) Pneumonia: - Consolidation or "hepatization of the lung" - Supleural Consolidations - "Shred" sign - Unilateral B-lines or bilateral B-lines - Possible small plural effusion - Reduced lung sliding due to thickened pleura in severe cases - Dynamic air bronchograms (atelectasis has static bronchograms) Cardiogenic Pulmonary Edema: - Widespread and bilateral B-lines - Normal lung sliding - Possible bilateral effusion depending on the severity Acute Respiratory Distress Syndrome (ARDS): - Bilateral or unilateral B-lines - Normal lung sliding COPD or Asthma: - Bilateral A-lines - Reduced lung sliding Pulmonary Embolism (PE): - Bilateral A-Lines - Deep Vein Thrombosis in Upper or Lower Extremities - Right Ventricular Enlargement (massive/submassive PE) POCUS 101 @Pocus101 #pulmonary #differential #diagnosis #signs #Lung #POCUS #ultrasound #findings

Dynamic Air Bronchograms on Lung on Point of Care Ultrasound The mesmerizing and oddly satisfying appearance of dynamic air bronchograms on lung ultrasound. A helpful finding to differentiate pneumonia from atelectasis. by Dr. Hailey Hobbs @haileyahobbs #Dynamic #AirBronchograms #Lung #pulmonary #clinical #ultrasound #pocus

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Dynamic Air Bronchograms on Lung on Point of Care Ultrasound If you're looking for something to stare at for a few hours, how about these dynamic air bronchograms? by Dr. Hailey Hobbs @haileyahobbs #Dynamic #AirBronchograms #Lung #pulmonary #clinical #ultrasound #pocus

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Dynamic Air Bronchograms on Lung Point of Care Ultrasound (POCUS) If you're looking for something to stare at for a few hours, how about these dynamicairbronchograms? - Dr. Hailey Hobbs @haileyahobbs #Dynamic #AirBronchograms #Lung #Ultrasound #POCUS #Clinical #Pulmonary

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ABCs of Lung Ultrasound - A-Lines, B-Lines, Consolidation A-Profile - Air filled lung does not transmit sound waves, leading to A-line (reverberation) artifact B-Profile - Interstitium widens to allow propagation of ultrasound beams past the pleural interface C-Profile - Filled alveoli lead to a consolidated portion of lung (not air-filled) • If bronchioles are air filled: static air bronchograms will be seen • If bronchioles are partially fluid filled: dynamic air bronchograms may be seen • If bronchioles are fluid filled: fluid bronchograms may be seen C-Profile - Collapsed alveoli lead to a consolidated portion of lung (not air-filled) • If bronchioles are completely collapsed: no air bronchograms will be seen • If bronchioles are open or partially collapsed: static air bronchograms will be seen IM POCUS Focus @IMPOCUSFocus #ABCs #Lung #Profiles #Ultrasound #POCUS #Differential #Diagnosis #clinical #pulmonary

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ABCs of Lung Ultrasound - A-Lines, B-Lines, Consolidation A-Profile - Air filled lung does not transmit sound waves, leading to A-line (reverberation) artifact B-Profile - Interstitium widens to allow propagation of ultrasound beams past the pleural interface C-Profile - Filled alveoli lead to a consolidated portion of lung (not air-filled) • If bronchioles are air filled: static air bronchograms will be seen • If bronchioles are partially fluid filled: dynamic air bronchograms may be seen • If bronchioles are fluid filled: fluid bronchograms may be seen C-Profile - Collapsed alveoli lead to a consolidated portion of lung (not air-filled) • If bronchioles are completely collapsed: no air bronchograms will be seen • If bronchioles are open or partially collapsed: static air bronchograms will be seen IM POCUS Focus @IMPOCUSFocus #ABCs #Lung #Profiles #Ultrasound #POCUS #Differential #Diagnosis #pulmonary

Lung Ultrasound: Cardiogenic Pulmonary Edema vs ARDS Cardiogenic Pulmonary Edema: • Smooth pleural line • AIS > 3 B-lines/ lung zone • Diffuse / homogenous • Often anterior and posterior. But may be P > A, Normal sliding • Lung consolidation is not characteristic Non-cardiogenic pulmonary edema / ARDS: • Irregular pleural line + sub-pleural opacities • AIS > 3 B-lines / lung zone • Diffuse, "patchy". Areas of sparing • +/- Reduced sliding. Lung "Pulse" • + Posterior lung consolidations & air bronchograms - Alberta Sono @UAlberta_Sono #APE #ARDS #pulmonary #edema #comparison #clinical #diagnosis #ultrasound

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Air Bronchograms in Pneumonia on Lung Ultrasound Extreme shortness of breath... pretty easy to appreciate this large pneumonia on POCUS. Here there is consolidation in the distribution of large bronchi, and subtle dynamic air bronchograms. Eric Abrams, MD @eabramsMD #Air #Bronchograms #Pneumonia #Lung #Ultrasound #clinical #pocus #Pulmonary

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Lung sliding & pneumonia on POCUS The differential diagnosis for absence of lung sliding includes pneumonia; however, the absence of sliding alone is rarely the only finding. Generally, pneumonia that reduces aeration to the point that there is a reduction or cessation of sliding will result in ancillary findings including presence of multiple B-lines, sub-pleural consolidation, and/or progression to dense consolidation— regardless of position on thorax. While it is possible to have dense consolidation that does not reach the pleural interface—this pattern of medial and dense consolidation is less common. Example is acquired from the anterior chest wall (mid-clavicular). - Alberta Sono @UAlberta_Sono #absent #absence #Lung #sliding #pneumonia #POCUS #clinical #ultrasound #pulmonary #mimics

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Pneumonia! With dynamic air bronchograms, lung hepatization, and multiple B-lines 40ish yo M presents with AMS and respiratory failure. Diminished breath sounds on the R lung base. Dynamic air bronchograms are the visualization of air movement (the sparkle) within the bronchi. It suggests pneumonia over atelectasis. - Dr. Christopher Kumetz @ChrisKumetz #Pneumonia #Dynamic #AirBronchograms #Clinical #POCUS #Lung #Ultrasound #Hepatization

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Lung Collapse with Hepatization and Static Air bronchograms For mucus plug: Hepatization w static bronchograms. These images were obtained d/t sudden hypoxia post procedural sedation. Unilateral white out on CXR. Complete resolution on US and CXR after suctioning. - Dr. David Mackenzie @mackendc #Lung #Collapse #Hepatization #Static #AirBronchograms #clinical #ultrasound #pulmonary #pocus

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B-Lines on Lung Point of Care Ultrasound (POCUS) ... Stethoscope: [Oh, sounds like wheezing. Let's give nebs!] Ultrasound: [You idiot, can't you see the B lines!?] - Dr. Dan Kim @dan___kim #BLines #POCUS #Clinical #Pulmonary #Lung #Ultrasound

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Dynamic Air Bronchograms on Lung POCUS Scanning right pectoral region. POCUS appearance of pneumonia, with consolidated ("hepatized") lung, dynamic air bronchograms and consolidated lung providing a window to heart. #Dynamic #Air #Bronchograms #Lung #POCUS #clinical #ultrasound #pocus

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Dynamic Air Bronchograms on Lung POCUS Pneumonias look for Dynamic Air Bronchgrams within your consolidation. POCUS 101 @Pocus101 #Dynamic #AirBronchograms #POCUS #clinical #ultrasound #pulmonary #pneumonia

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Air Bronchograms on Ultrasound Opacification of alveolar spaces surrounding air-filled bronchioles; enables visualization of well-defined tissue/air interface; dynamic air bronchograms (AB) are bronchioles still in continuity with central airways, move dynamically with respiration, and are more often seen in infected consolidation; static AB are bronchioles ex-communicated from the main trachea-bronchial tree, often seen secondary to another process including large effusions, substantial atelectasis, but can also be seen in infected consolidation. - UAlbertaCritCareUS @UAlberta_CCUS #AirBronchograms #Static #Dynamic #POCUS #Clinical #Lung #Ultrasound #comparison

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Dynamic Air Bronchograms of Pneumonia on Lung POCUS One of the best images of dynamic air bronchograms in pneumonia I’ve seen so far Abhilash Koratala MD - NephroPOCUS @NephroP #Dynamic #AirBronchograms #Pneumonia #Lung #POCUS #pulmonary #ultrasound

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COVID-19 Lung POCUS Common findings -B lines -Subpleural consolidation -Air bronchograms -Irregular pleural line -Localized pleural effusion Dr. Marco Garrone @drmarcogarrone #COVID19 #POCUS #Clinical #Lung #Ultrasound #SARSCoV2 #Coronavirus

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Dynamic Air Bronchograms on Lung POCUS Dr. Ashley Miller @icmteaching #Dynamic #AirBronchograms #Lung #POCUS #clinical #ultrasound #pulmonary

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Lung POCUS: "Hepatization" with fluid bronchograms and dynamic air bronchograms in patient with lobar consolidation due to bacterial pneumonia. Pattern more commonly seen with bacterial pneumonia. Curvilinear probe used. Dr. Robert Jones @RJonesSonoEM #AirBronchograms #Hepatization #Bacterial #Pneumonia #Lung #POCUS #Pulmonary #Ultrasound #Clinical

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Dynamic Air Bronchograms on Lung POCUS More likely pneumonia than atelectasis. 94% spec in small study Dr. Michael I. Prats @PratsEM #Dynamic #Air #Bronchograms #Lung #POCUS #pulmonary #ultrasound #clinical

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