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COPD: Andrew Slater, Mark Goodwin, Kirsty E. Anderson, and Fergus V. Gleeson COPD Can Mimic the Appearance of Pneumothorax on Thoracic Ultrasound Chest 2006; 129: 545-550 [Abstract] [Full text] [PDF]

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Not so eFAST...

Fernando R Silva, Emergency Medicine Residency   (15 March 2006)

Not so eFAST... 15 March 2006
Fernando R Silva, Emergency Physician Hospital de Pronto Socorro de Porto Alegre, Emergency Medicine Residency Send letter to journal: Re: Not so eFAST... fernando.hps{at}terra.com.br Fernando R Silva, et al.	Dear authors, First, I would like to congratulate the authors for researching on such a new and enriching field in emergency medicine, lung ultrasound. I would only make a couple comments on the method. Lung ultrasound, as long known, is primarily based on analyzing artifacts, not images. These artifacts can be used to express tissue phenomena, as the B-lines (formerly "comet-tails") express extravascular lung water, and lung sliding expresses visceral pleura touching parietal pleura. Lichtestein and others have already found that some normal subjects do not express lung sliding. That's why they studied the artifacts generated by the motion of the alveolar surface itself, the subtle "sparkling" artifacts way below the pleural line image, describing the M-mode generated "seashore sign" and "stratosphere sign". They mean no pneumothorax and present pneumothorax, respectively. These signs do not depend on the visualization of the pleural line, and are much more sensitive and specific (maybe further study shall be made to reinforce this affirmation), because they are altered by the submilimetric alveolar structure and every tiny movement, with marked sonographic expression. Unfortunately the present study did not use this tool, which makes such a great difference in clinical practice and, naturally, would have given different statistic results. Thank you, Fernando Ribeiro Silva, MD Lichtenstein DA et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005 vol.33, no.6 p. 1231