Lung Point

Intensivists are required to put in multiple central lines in critically ill patients.  One of the dreaded complications of line placement is a pneumothorax.  This complication is typically ruled out with a post-procedural chest xray.  Since most central lines are now being inserted with ultrasound guidance, it is an easy adjunct to the procedure to check with the ultrasound for a “lung point” that is seen with a pneumothorax.

LUNG POINT is an ultrasound sign showing a fleeting appearance of a lung pattern (lung sliding or pathologic comet-tail artifacts) replacing a pneumothorax pattern (absent lung sliding plus exclusive horizontal lines) in a particular location of the chest wall.

Sensitivity: 66 %
Specificity:  100%.

This link to a video of a lung point seen with an ultrasound opens in a new window/tab.

Lung point must not be just found, but actively sought for.
A lung point found by chance (esp anteriorly near the sternum) has little chance to be a PTx.

Regular M-mode outlook of a lung point.

Mmode

Seashore sign seen on the left, arising from the pleural line.  Stratosphere sign (total absence of any dynamic arising from the pleural line) seen on the right.

References

Lichtenstein, Daniel et al. ‘The “Lung Point”: An Ultrasound Sign Specific To Pneumothorax’. Intensive Care Med 26.10 (2000): 1434-1440. Web.

Moreno-Aguilar, German, and Daniel Lichtenstein. ‘Lung Ultrasound In The Critically Ill (LUCI) And The Lung Point: A Sign Specific To Pneumothorax Which Cannot Be Mimicked’. Critical Care 19.1 (2015): n. pag. Web.

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