USG lung pneumonia

• The ultrasonographic findings of pneumonia in child include lung

consolidation with irregular margins and surrounding multiple B-lines. The
pleural line is not visible in the area, and lung sliding is absent

• Dynamic air bronchograms (branch structures) are visible in large

consolidations and represent bronchial patency, which excludes
atelectasis
• The ultrasonographic features of atelectasis include large lung
consolidation with well-defined borders, pleural line abnormalities, and the
absence of lung sliding
• Shred sign: It is characterized as the border between the aerated lung
and consolidated lung not being sharp

• The shred sign is the most common ultrasonic sign of Pulmonary

Hemorrhage of the Newborn (PHN), occurring in more than 90% of the
patients

• The shred sign was the main ultrasonic finding in mild PHN patients or
within the lung on the side with mild bleeding

• In addition, the shred sign was often found at the edge of large areas of
consolidation
Lung sliding Rhythmic movement of pleural line with respiration. It represents
sliding of the visceral pleura against the parietal pleura.

A-lines Horizontal lines equally spaced from pleural line, representing

artifact generated by subpleural air, a normal finding.

B-lines Vertical lines arising from pleura and extending to base of the
image.
Pleural abnormality Disruption of pleural line.
Consolidation Hypoechoic circumscribed disruption of pleural line extending
inferiorly and may contain any of the following; Air bronchogram,
Shred sign, Pleural effusion.
Air bronchogram Punctate or branching hyperechoic images reflecting airways
made visible by surrounding fluid/inflammation
Shred sign Irregular border of consolidation
Pleural effusion Anechoic space between visceral and parietal pleura.
Stratosphere sign/barcode sign
Stratosphere sign/barcode sign: Under M-mode ultrasonography, when
lung sliding diseapear, the granular dot echoes are replaced by a series of
horizontal parallel lines and this type of ultrasonic sign is known as a
stratosphere or barcode sign.
Cao HY, Sorantin E. Sonographic manifestation of normal lung. In: Neonatal Lung Ultrasonography. Liu
J, Sorantin E, Cao HY, editors. Dordrecht:Springer. 2017:13.

Several other studies highlight the utility of ultrasound compared to CXR for
the diagnosis of pneumothorax in the Emergency Department. The
sensitivity of ultrasound in certain studies has been similar to that found in
CT scan, which is still considered to be the gold standard for the detection
of a pneumothorax. Lichtenstein et al., have shown that ultrasound has a
sensitivity of 95.3% and a specificity of 91.1% for detecting pneumothorax
in intensive care unit (ICU) patients.
Husain LF, Hagopian L, Wayman D, Baker WE, CArmody KA. Sonographic diagnosis of pneumothorax.
J Emerg Trauma Shock. 2012;5:76-81.
Stratosphere sign/barcode sign
Stratosphere sign/barcode sign
Sinusoid sign
Quad sign

Pleural effusion. Left and middle: minute pleural effusion at the PLAPS-point. Below the pleural line,
a line regular and roughly parallel to the pleural line can be seen: the lung line, indicating the
visceral pleura (arrows). This line, together with the pleural line and the shadow of the ribs, display
a kind of quad: the quad sign. Right: M-mode shows a movement of the lung line (white arrows)
toward the pleural line (black arrows) on inspiration—the sinusoid sign, indicating also a free
pleural effusion, and a viscosity enabling the use of small caliper needle if thoracentesis is
envisaged. E, expiration. Quantitative data: this effusion found at the PLAPS-point has an expiratory
thickness of roughly 13 mm, i.e., an expectedly small volume (study in progress). A 15-mm distance
is our minimum required for safe diagnostic or therapeutic puncture, allowing to simplify the
problem of modeling the real volume of an effusion (Ref. 14). Extract from “Whole body
ultrasonography in the critically ill” (2010 Ed, Chapter 15), with kind permission of Springer Science.
Jellyfish Sign
LUNG POINT

• Zona transisi antara lung sliding dan tidak adanya lung sliding pada
pemeriksaan USG

• Lung point merupakan tanda spesifik untuk pneumothorax

(sensitivitas 66% dan spesivisitas 100%)
MUU