Figures
- FIGURE 1
a) Thoracic ultrasound using low frequency probe oriented perpendicular to the intercostal space long axis. Note how the ribs (arrowheads) cast deep shadows causing interruption to the pleural line (arrows). b) The same image after orienting the probe to remove the rib shadows. Note the continuous pleural line (arrow).
- FIGURE 2
a) The upper part of the image is an ultrasound still in B-mode of pleural effusion and hemidiaphragm, with a green line traversing the middle. The lower part of the image corresponds to the M-mode image acquired for the structures traversed by the green line moving over time. Note the wavy white line and the + marks pointing to the degree of diaphragm excursion in one respiratory cycle. b) Doppler examination showing an unshielded intercostal vessel in the deep part of the chest wall. c) Right pleural effusion, collapsed lung and convex thickened hemidiaphragm (arrowhead). Malignancy is confirmed by the presence of a nodule (arrow) on the diaphragm. d) Under real-time ultrasound guidance a core-cutting needle (arrows) is advanced to biopsy the parietal pleural thickening, the extent of which is indicated by two arrowheads.
- FIGURE 3
a) Non-echogenic pleural effusion and part of the collapsed lung. b) Highly echogenic effusion and underlying diaphragm. c) Complex septated right pleural effusion.
- FIGURE 4
Three images showing the effect of the weight of pleural effusion on the configuration of the corresponding hemidiaphragm that changes from a) its normal convex shape, b) to be flattened and c) with larger effusions becoming inverted.
Tables
- TABLE 1
Advantages and pitfalls of using ultrasound in pleural diseases
Advantages
Pitfalls
Widely available
Operator dependent Relatively cheap
Not suitable for examinations in patients with subcutaneous emphysema
Mobile – ideal point-of-care test
Difficult to examine patients with narrow intercostal spaces (e.g. fibrothorax)
Lack of ionising radiation (making the test safe to repeat)
Inferior to computed tomography in delineating complex pleural spaces (e.g. multi-loculated hydropneumothorax) Improves safety of pleural procedures
Allows real-time invasive procedure guidance
More sensitive than computed tomography for pleural fluid characterisation
Supplementary Material
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ERR-0136-2019_supplementary_figures ERR-0136-2019_supplementary_figures
