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Published in: The Ultrasound Journal 1/2012

Open Access 01-12-2012 | Short communication

The V-line: a sonographic aid for the confirmation of pleural fluid

Authors: Paul Atkinson, James Milne, Osama Loubani, Glenn Verheul

Published in: The Ultrasound Journal | Issue 1/2012

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Abstract

Background

Ultrasound is being used increasingly to diagnose pathological free fluid accumulation at the bedside. In addition to the detection of peritoneal and pericardial fluid, point-of-care ultrasound allows rapid bedside diagnosis of pleural fluid.

Findings

In this short report, we describe the sonographic observation of the vertebral or ‘V-line’ to help confirm the presence of pleural fluid in the supine patient. The V-line sign is a result of the fluid acting as an acoustic window to enable visualization of vertebral bodies and posterior thoracic wall, thus confirming the presence of pleural fluid.

Conclusions

The V-line is a useful sonographic sign to aid the diagnosis of pleural free fluid.
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Literature
1.
go back to reference Koh DM, Burke S, Davies N, Padley SP: Transthoracic US of the chest: clinical uses and applications. Radiographics 2002, 22: e1.PubMedCrossRef Koh DM, Burke S, Davies N, Padley SP: Transthoracic US of the chest: clinical uses and applications. Radiographics 2002, 22: e1.PubMedCrossRef
2.
go back to reference Knudsen CW, Omland T, Clopton P, Westheim A, Abraham WT, Storrow AB, McCord J, Nowak RM, Aumont MC, Duc P, Hollander JE, Wu AH, McCullough PA, Maisel AS: Diagnostic value of B-type natriuretic peptide and chest radiographic findings in patients with acute dyspnea. Am J Med 2004,116(6):363–368. 10.1016/j.amjmed.2003.10.028PubMedCrossRef Knudsen CW, Omland T, Clopton P, Westheim A, Abraham WT, Storrow AB, McCord J, Nowak RM, Aumont MC, Duc P, Hollander JE, Wu AH, McCullough PA, Maisel AS: Diagnostic value of B-type natriuretic peptide and chest radiographic findings in patients with acute dyspnea. Am J Med 2004,116(6):363–368. 10.1016/j.amjmed.2003.10.028PubMedCrossRef
3.
go back to reference Mattison LE, Coppage L, Alderman DF, Herlong JO, Sahn SA: Pleural effusions in the medical ICU: prevalence, causes and clinical implications. Chest 1997, 111: 1018–1023. 10.1378/chest.111.4.1018PubMedCrossRef Mattison LE, Coppage L, Alderman DF, Herlong JO, Sahn SA: Pleural effusions in the medical ICU: prevalence, causes and clinical implications. Chest 1997, 111: 1018–1023. 10.1378/chest.111.4.1018PubMedCrossRef
4.
go back to reference Sisley AC, Rozycki GS, Ballard RB, Namias N, Salomone JP, Feliciano DV: Rapid detection of traumatic effusion using surgeon-performed ultrasonography. J Trauma 1998,44(2):291–297. 10.1097/00005373-199802000-00009PubMedCrossRef Sisley AC, Rozycki GS, Ballard RB, Namias N, Salomone JP, Feliciano DV: Rapid detection of traumatic effusion using surgeon-performed ultrasonography. J Trauma 1998,44(2):291–297. 10.1097/00005373-199802000-00009PubMedCrossRef
5.
go back to reference Ma OJ, Mateer JR: Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med 1997,29(3):312–316. 10.1016/S0196-0644(97)70341-XPubMedCrossRef Ma OJ, Mateer JR: Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med 1997,29(3):312–316. 10.1016/S0196-0644(97)70341-XPubMedCrossRef
6.
go back to reference Ma OJ, Mateer JR, Ogata M, Kefer MP, Wittmann D, Aprahamian C: Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma 1995,38(6):879–885. 10.1097/00005373-199506000-00009PubMedCrossRef Ma OJ, Mateer JR, Ogata M, Kefer MP, Wittmann D, Aprahamian C: Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma 1995,38(6):879–885. 10.1097/00005373-199506000-00009PubMedCrossRef
7.
go back to reference Rothlin MA, Näf R, Amgwerd M, Candinas D, Frick T, Trentz O: Ultrasound in blunt abdominal and thoracic trauma. J Trauma 1993,34(4):488–495. 10.1097/00005373-199304000-00003PubMedCrossRef Rothlin MA, Näf R, Amgwerd M, Candinas D, Frick T, Trentz O: Ultrasound in blunt abdominal and thoracic trauma. J Trauma 1993,34(4):488–495. 10.1097/00005373-199304000-00003PubMedCrossRef
8.
go back to reference Rozycki GS, Ochsner MG, Schmidt JA, Frankel HL, Davis TP, Wang D, Champion HR: A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma 1995, 39: 492–500.PubMedCrossRef Rozycki GS, Ochsner MG, Schmidt JA, Frankel HL, Davis TP, Wang D, Champion HR: A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma 1995, 39: 492–500.PubMedCrossRef
9.
go back to reference Brooks A, Davies B, Smethhurst M, Connolly J: Emergency ultrasound in the acute assessment of haemothorax. Emerg Med J 2004,21(1):44–46. 10.1136/emj.2003.005438PubMedCentralPubMedCrossRef Brooks A, Davies B, Smethhurst M, Connolly J: Emergency ultrasound in the acute assessment of haemothorax. Emerg Med J 2004,21(1):44–46. 10.1136/emj.2003.005438PubMedCentralPubMedCrossRef
10.
go back to reference Kimura A, Otsuka T: Emergency center ultrasonography in the evaluation of hemoperitoneum: a prospective study. J Trauma 1991,31(1):20–23. 10.1097/00005373-199101000-00004PubMedCrossRef Kimura A, Otsuka T: Emergency center ultrasonography in the evaluation of hemoperitoneum: a prospective study. J Trauma 1991,31(1):20–23. 10.1097/00005373-199101000-00004PubMedCrossRef
11.
go back to reference Wong CL, Holroyd-Leduc J, Straus SE: Does this patient have a pleural effusion? JAMA 2009,301(3):309–317. 10.1001/jama.2008.937PubMedCrossRef Wong CL, Holroyd-Leduc J, Straus SE: Does this patient have a pleural effusion? JAMA 2009,301(3):309–317. 10.1001/jama.2008.937PubMedCrossRef
12.
go back to reference Colins JD, Burwell D, Furmanski S, Lorber P, Steckel RJ: Minimal detectable pleural effusions A roentgen pathology model. Radiology 1972,105(1):51–53.PubMedCrossRef Colins JD, Burwell D, Furmanski S, Lorber P, Steckel RJ: Minimal detectable pleural effusions A roentgen pathology model. Radiology 1972,105(1):51–53.PubMedCrossRef
13.
go back to reference Woodring JH: Recognition of pleural effusion on supine radiographs: how much fluid is required? AJR Am J Roentgenol 1984,142(1):59–64.PubMedCrossRef Woodring JH: Recognition of pleural effusion on supine radiographs: how much fluid is required? AJR Am J Roentgenol 1984,142(1):59–64.PubMedCrossRef
14.
go back to reference Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ: Comparative diagnostic performances of auscultation, chest radiography and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004, 100: 9–15. 10.1097/00000542-200401000-00006PubMedCrossRef Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ: Comparative diagnostic performances of auscultation, chest radiography and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004, 100: 9–15. 10.1097/00000542-200401000-00006PubMedCrossRef
15.
go back to reference Joyner CR, Herman RJ, Reid JM: Reflected ultrasound in the detection and localization of pleural effusion. JAMA 1967, 200: 399–402. 10.1001/jama.1967.03120180087013PubMedCrossRef Joyner CR, Herman RJ, Reid JM: Reflected ultrasound in the detection and localization of pleural effusion. JAMA 1967, 200: 399–402. 10.1001/jama.1967.03120180087013PubMedCrossRef
16.
go back to reference Walz M, Muhr G: Sonographische diagnostik beim stumpfen thoraxtrauma. Unfallchirurg 1990, 93: 359.PubMed Walz M, Muhr G: Sonographische diagnostik beim stumpfen thoraxtrauma. Unfallchirurg 1990, 93: 359.PubMed
17.
go back to reference Beckh S, Bölcskei PL, Lessnau KD: Real-time chest ultrasonography: a comprehensive review for the pulmonologist. Chest 2002, 122: 1759. 10.1378/chest.122.5.1759PubMedCrossRef Beckh S, Bölcskei PL, Lessnau KD: Real-time chest ultrasonography: a comprehensive review for the pulmonologist. Chest 2002, 122: 1759. 10.1378/chest.122.5.1759PubMedCrossRef
18.
go back to reference Volpicelli G, Caramello V, Cardinale L, Mussa A, Bar F, Frascisco MF: Detection of sonographic B-lines in patients with normal lung or radiographic alveolar consolidation. Med Sci Monit 2008, 14: CR122.PubMed Volpicelli G, Caramello V, Cardinale L, Mussa A, Bar F, Frascisco MF: Detection of sonographic B-lines in patients with normal lung or radiographic alveolar consolidation. Med Sci Monit 2008, 14: CR122.PubMed
19.
20.
go back to reference Volpicelli G: Sonographic diagnosis of pneumothorax. Intensive Care Med 2011, 37: 224. 10.1007/s00134-010-2079-yPubMedCrossRef Volpicelli G: Sonographic diagnosis of pneumothorax. Intensive Care Med 2011, 37: 224. 10.1007/s00134-010-2079-yPubMedCrossRef
21.
go back to reference Lichtenstein DA, Menu Y: A bedside ultrasound sign ruling out pneumothorax in the critically ill Lung sliding. Chest 1995, 108: 1345. 10.1378/chest.108.5.1345PubMedCrossRef Lichtenstein DA, Menu Y: A bedside ultrasound sign ruling out pneumothorax in the critically ill Lung sliding. Chest 1995, 108: 1345. 10.1378/chest.108.5.1345PubMedCrossRef
22.
go back to reference Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T, International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS): International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012,38(4):577–591. 10.1007/s00134-012-2513-4PubMedCrossRef Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T, International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS): International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012,38(4):577–591. 10.1007/s00134-012-2513-4PubMedCrossRef
Metadata
Title
The V-line: a sonographic aid for the confirmation of pleural fluid
Authors
Paul Atkinson
James Milne
Osama Loubani
Glenn Verheul
Publication date
01-12-2012
Publisher
Springer Milan
Published in
The Ultrasound Journal / Issue 1/2012
Electronic ISSN: 2524-8987
DOI
https://doi.org/10.1186/2036-7902-4-19

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