We have added lung scans of patients with and without pneumothoraces. Test yourself!
Lung sliding. Shimmering beneath pleural line . No pneumothorax
No lung sliding . No shimmering beneath pleural line . Pneumothorax
No pneumothorax. Lung pulse visible. Note vertical artifacts from deep to the screen reaching the pleural line and stopping. This is due to transmitted cardiac pulsations. There is no pneumothorax. The patient is breath holding.
This is a pneumothorax. There is no lung pulse ie no vertical artifacts from deep to the screen reaching the pleural line. The image below the pleural line shows vertical lines similar to what is above the pleural line. This is called the “stratosphere” or “barcode sign”
This is not a pneumothorax. No landmarks are visible such as the rib shadows. There is no pleural line. The artifact produced deep to the bright irregular line is due to air from subcutaneous emphysema
Pneumothorax. On the far right of the screen the transition point is just visible. This is where lung sliding occurs again ie the point where the pneumothorax ends.
No pneumothorax. There is shimmering beneath the pleural line. Lung sliding is difficult to appreciate. M mode clearly shows the lung pulse indicating that a pneumothorax is not present.
This is the transition point of the pneumothorax. The point at which the pneumothorax ends and there is no air between the visceral and parietal pleura. This can be visualised using M mode. The pneumothorax on respiration will pass through the line of sight of the M mode with inspiration and move out on expiration. There will therefor be a stratoshere sign (pneumothorax) alternating with a seashore sign (no pneumothorax)