Summary

• PoCUS is sensitive, and specific for the detection of pleural effusions.
• Position the probe in the posterior axillary line with the marker towards the head
• Identify the liver/spleen, diaphragm, vertebral bodies and lung
• The characteristic (positive) finding is a hypoechoic collection above the diaphragm with distinct borders and dynamic movement.
• Don’t forget to document your findings in the chart and save images for QA.

References

1. Grimberg et al. Diagnostic accuracy of sonography for pleural effusion: systematic review. Sao Paulo Med J (2010) 128;2: 90-95.

2. Asthon-Cleary, DT. Is thoracic ultrasound a viable alternative to conventional imaging in the critical care setting? BJA (2013) doi:10.1093/bja/aet076

3. Kurian et al. Comparison of Ultrasound and CT in the Evaluation of Pneumonia Complicated by Parapneumonic Effusion in Children. AJR (2009) DOI:10.2214/AJR.09.2791

4. Calder and Owens. Imaging of parapneumonic pleural effusions and empyema in children. Ped Rad (2009) DOI: 10.1007/s00247-008-1133-1

5. Volpicelli et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med (2012) DOI:10.1007/s00134-012-2513-4

6. Islam et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Ped Surg (2012) DOI: 10.1016/j.jpedsurg.2012.07.047

7. Peris et al. The Use of Point-of-Care Bedside Lung Ultrasound Significantly Reduces the Number of Radiographs and Computed Tomography Scans in Critically Ill Patients. Anesth&Analg (2010) DOI: 10.1213/ANE.0b013e3181e7cc42

8. Jones BP, Tay ET, Elikashvili I, Sanders JE, Paul AZ, Nelson BP, Spina LA, Tsung JW, Feasibility and Safety of Substituting Lung Ultrasound for Chest X-ray When Diagnosing Pneumonia in Children: A Randomized Controlled Trial, CHEST (2016), doi: 10.1016/j.chest.2016.02.643