Evaluation of pneumothorax by bedside ultrasonography*

* Lung ultrasound is an advanced skill that can be challenging for clinicians who have not completed appropriate training. Lung ultrasound is generally only performed in stable patients with suspected pneumothorax. Imaging is often not performed during emergency conditions when tension pneumothorax is suspected. Bedside ultrasound is more useful for the exclusion of pneumothorax than for confirmation of one.
¶ Rarely, a loculated pneumothorax may be present in a dependent position in the thorax. This may require examination in a different position and location on the chest wall.
Δ The absence of lung sliding suggests the possibility of pneumothorax, but it is not specific. Thus, the operator should look for evidence of a lung point or lung pulse, which can confirm or exclude pneumothorax, respectively.
◊ The presence of B lines rules out pneumothorax even if there is absence of lung sliding at the site of the examination, as B lines originate at the visceral pleural surface.
§ The presence of a lung point, although diagnostic of pneumothorax, may not always be present.