Ultrasound for Critical Care Physicians: Lung Sliding and the Seashore Sign

Spencer M. Lee, MD

Gregory T. Chu, MD

Banner Good Samaritan Medical Center

Phoenix, AZ

A 70-year-old Native American woman was having increasing difficulty with ventilation. She had an extensive past medical history including quadriplegia after a motor vehicle accident in 2009, chronic mechanical ventilation since the accident, end-stage renal disease, and diabetes mellitus. A feeding tube had recently been inserted. A portable chest radiograph was performed (Figure 1).

Figure 1. Portable chest radiograph.

A lung ultrasound was performed (Figure 2).

Figure 2. Lung ultrasound of the left lung (upper panel) and of the right lung (lower panel).

M-mode images of the ultrasound are shown in Figure 3.

Figure 3. M-mode image of the left lung (panel A on left) and the right lung (Panel B on right).

Which of the following are true regarding the images presented? (Click on the correct answer to procced to the next and final panel)

1. The chest x-ray shows the feeding tube in the right lung
2. The M-mode image shows the seashore sign on the left suggestive of a pneumothorax
3. The ultrasound shows an absence of lung sliding on the right suggestive of a pneumothorax
4. 1 and 3
5. All of the above

Reference as: Lee SM, Chu GT. Ultrasound for critical care physicians: lung sliding and the seashore sign. Southwest J Pulm Crit Care. 2014;9(6):337-40. doi: http://dx.doi.org/10.13175/swjpcc163-14 PDF