What is lung sliding?

What is the difference between lung sliding and lung pulse?

What is the best ultrasound method to detect lung sliding?

What is the differential diagnosis for absence of lung sliding?

What is lung point?

Besides lung sliding, what other two common artifacts can help with differential diagnosis?

Lung sliding is the movement of the pleural interface in a synchronous fashion with spontaneous or mechanical ventilation. The parietal and visceral pleura constitute the pleural interface, which is a hyperechoic structure between two ribs on bidimensional ultrasound. It is maximized in the lower lung fields, as the lung descends toward the abdomen. Lung sliding identification is the most commonly used artifact in the exclusion of pneumothorax as well as in the confirmation of endotracheal intubation [2].

Lung pulse artifact is a small to-and-fro movement of the visceral on the parietal pleura induced by the heartbeat rather than respirations. It is more prominent on the left side, closer to the heart. In order for it to be visualized, ventilation and, consequently, lung sliding must be absent. It implies an intact pleural interface, and its presence excludes a pneumothorax.

M-mode ultrasound is the preferred method for lung movement imaging, producing the characteristic “seashore sign” (Fig. 60.1). This image has two portions. The superficial part (top of the figure) is typically composed of multiple horizontal lines that correspond to motionless soft tissue. It ends on the pleural line. The other portion corresponds to the motion of the normal lung. This motion generates an artifact that originates from the pleural line and looks like sand on a beach. The image on its entirety looks like water waves in the ocean touching the sand on a beach.