Two cases where bedside ultrasound was able to distinguish pulmonary bleb from pneumothorax
Barry C. Simon, Lauri Paolinetti
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In the video clip of the normal lung the dense horizontal white line about 1/3 of the distance from the top of the image represents the pleura. With respiration one will normally see the pleura ‘sliding’ horizontally, to and fro. Bright white ‘spots,’ ‘nodes,’ appear intermittently as the pleura slides. White streaks, reverberation artifacts, sporadically emanate off the pleura and streak down, away from the pleura.
In M mode the sonogram is looking for evidence of motion. Motion appears granular in M mode whereas the absence of motion will be evident as a series of horizontal lines. In this video clip of a normal lung the M mode video demonstrates diffuse granularity confirming the presence of movement.
In the video clip of the chest with a pneumothorax, a similar pleural line is seen. Movement of the chest wall can be noted but the sliding seen in the clip of the normal chest is absent. Also absent are the bright white nodes and any evidence of streaking. In M mode the tissue distal to the pleura appears as a series of horizontal lines that one would expect if there is no movement of lung tissue deep to the pleura.
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