Pneumothorax

Normally the parietal and visceral pleura slide against each other

• Look at the pleural line just under the rib
• Shimmer of the surfaces sliding (Video 1)
• Line of pearls

A pneumothorax will allow air between the pleural surfaces

• No sliding (Video 2)
• Loss of signal after parietal pleura
• Will still see the white line of parietal pleura but no shimmer
• Compare to other side to see normal lung sliding
• Can be harder to diagnose with bilateral pneumothorax

Look for lung point

• Unless complete collapse there will be a lung point
• Transition where pleural surfaces separate
• See change from sliding to no-sliding (Video 3 and 4)

M-mode can confirm pneumothorax

• Normal M-mode-Seashore (Figure 1)
• Abnormal loss of signal, sometimes called Barcode sign (Figure 2)

Figure 1 - Normal M-mode (Seashore)

Figure 2 - Abnormal M-mode (Barcode)

Clip 1 - Normal Lung Sliding

Clip 2 - Abnormal Lung Lack of Sliding

Clip 3 - Lung Point

Clip 4 - Lung Point

Lichtenstein, Daniel A. “Lung ultrasound in the critically ill.” Annals of intensive care 4.1 (2014): 1.