Indications

• Dyspnea
• Cough
• Fever without a source

 

Equipment

• Ultrasound machine
• High frequency linear probe (6-12 MHz) is most used, although a curvilinear or phased array probe may also be used
• Gel

 

Technique 

1. Position the patient: It is easiest to completely expose the thorax. LUS can be conducted with the patient in any number of positions; in the parent’s arms (helpful for posterior exam), seated on or lying in a stretcher (lateral decubitus can be used to examine the posterior chest).
2. Warm the gel if possible: Younger or sleeping patients may respond better if the gel is warmed. Consider warming the gel between your gloved hands and applying a layer of warmer gel to the chest.
3. Scan the patient:
   1. Set the depth to between 5 – 10 cm, choosing the smallest depth that gives an appropriate image to maximize resolution.
   2. Hold the probe with the marker pointed towards the patient’s head. Starting most cephalad with the probe in a sagittal orientation scan from the lung apex to the diaphragm.
   3. Complete this process in 6 planes: posterior between the spine and the scapula left and right chest, at the mid-axillary line left and right chest, and anteriorly at the midclavicular line left and right chest (figure 1)
   4. For any abnormalities detected, the area should be investigated more by sliding the probe along the rib space or changing the probe to a transverse view to scan in-between the ribs.

Figure 1: Scanning technique for pneumonia