Test yourself
Pleural effusion: find the spine above the diaphragm
5 questions. Pick an answer to see whether you are right and why. Your score appears at the end.
Question 1In a normal scan of the right lung base, why does the spine stop at the diaphragm?
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Answer a. Air scatters ultrasound, so aerated lung hides everything behind it. Below the diaphragm, the liver carries the beam to the spine. When fluid or consolidation replaces the air above the diaphragm, the beam reaches the spine there too, and it appears to continue upwards.
Question 2You see the spine continuing above the diaphragm, with tissue-like lung and branching bright air bronchograms. There is no black space. What is the most likely finding?
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Answer d. Consolidated lung carries the beam like solid tissue, so the spine sign appears without any fluid. Bright air bronchograms in tissue-like lung point to consolidation. An effusion needs a black, anechoic space. Normal lung and pneumothorax both hide the spine above the diaphragm.
Question 3Where do you place the probe to find a small effusion in a supine patient?
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Answer d. Fluid collects in the most dependent part of the chest, which in a supine patient is posterior and low. Push the probe back towards the bed. The second intercostal space in the mid-clavicular line is the window for pneumothorax, where air collects.
Question 4In a patient with a known effusion, you see a wedge of tissue moving in the fluid with breathing. What is it?
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Answer d. Compressed, airless lung floats or flaps in a large effusion and moves with breathing and the heartbeat. A clot or tumour does not change shape with breathing in this way. The diaphragm lies below the fluid as a bright curved line.
Question 5A febrile patient has a pleural effusion with strands and septations. What does this suggest?
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Answer a. Septations, strands and swirling echoes suggest an exudate, such as a parapneumonic effusion or empyema. In a febrile patient this needs urgent assessment and sampling. A simple transudate, from heart failure for example, is usually anechoic.
Practise it with us
Four or five delegates per instructor, FAMUS-accredited faculty and long, supervised time on the probe.
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