Lung

good example of lung sliding

good example of normal lung on abdominal preset - helpful to use this preset instead of the lung one in obese patients sometimes

lil bit of pleural thickening - pleural sliding on right side of image, peaks out from under rib

1 B-line flashing on the left side

b-line dropping like a plumb line from the pleura

in obese patients sometimes it's easier to use the abdominal preset for lung exams

the pleural line is at 4-5 cm and it's considered poor form to have it slant; you could level it out by rocking the probe - in this case tipping the tail of the probe caudad

almost confluent b lines in this interspace

some chewed up pleura (post COVID-19) with B lines

subpleural consolidation seen at about 2 cm - in setting of patchy areas of b-lines and the right clinical picture small subpleural consolidations (<1cm) can be indicative of atypical or viral pneumonia

another small subpleural consolidation

LUQ w/ curtain

RUQ - spine in far field (16-18 cm), as patient inhales the lung comes down and erases visible spine --> negative spine sign, no effusion

RUQ - lil curtain sign, neg spine sign

neg spine sign, curtain sign at end

RUQ view that's a bit anterior - you can tell bc a great vessel is visible in the far field. Great vessels sit superficial relative to the spine (duh), so you're not quite in the most posterior part of that diaphragmatic recess - when you don't catch the spine in RUQ and LUQ views your sensitivity for detecting an effusion goes down.

left pleural effusion, + spine sign

here's a good example of a left-sided effusion that needs a little more depth to appreciate the spine - atelectatic lung can be seen floating into view about midway through the clip on the probe marker side

this is what a really small effusion can look like - check the recess near the spine; when you can see the hyperechoic spine extend above the diaphragm that's a positive 'spine sign' and indicative of fluid in that space

nice effusion with atelectatic lung peaking into view during inspiration, little fluid under the diaphragm in the near field, too; positive spine sign

hemothorax on the left - sometimes with blood or other relatively proteinaceous fluid it's not entirely anechoic, though here it just looks like any other fluid

with spine sign in HD

pleural effusion + ascites combo, RUQ

another pleural effusion + ascites

cirrhotic whose diuretics were held, subsequently developed worsening shortness of breath --> image to right is from the same patient

malignant effusion + peritoneal carcinomatosis

reactive effusion following cholecystectomy; patient presented a few weeks post-op with dyspnea, improved after diuretic and thoracentesis