Ultrasound for Critical Care Physicians: Tiny Bubbles

Kashif Aslam, MD

Michel Boivin, MD

Division of Pulmonary, Critical care and Sleep Medicine

University of New Mexico School of Medicine

Albuquerque, NM

A 59 year old woman with a past medical history significant for stage IV MALT lymphoma (after chemotherapy and in remission) presented from a long term care facility for respiratory distress and altered mental status. The patient was in hypercarbic respiratory failure with a severe lactic acidosis. Her blood pressure deteriorated, she was begun on vasopressors and intubated.  Pertinent labs demonstrated a white blood cell count of 0.9 X10⁶ /ml, a hemoglobin of 7.1 g/dl, and a platelet count 66 X10⁶  /ml. The patient was started on Cefepime and Linezolid presumptively for septic shock. Ultrasounds of her thorax were performed (Videos 1 & 2).

Video 1.  Ultrasound of the right thorax in the mid-axillary line. 

 

Video 2.  Ultrasound of the right thorax in the mid-axillary line (slightly more caudad).

What is the best explanation for the ultrasound findings shown above? (Click on the correct answer for an explanation)

1. Large pleural effusion
2. Pneumothorax
3. Consolidation due to pneumonia
4. Ruptured diaphragm
5. Lung abscess

Reference as: Aslam K, Boivin M. Ultrasound for critical care physicians: tiny bubbles. Southwest J Pulm Crit Care. 2015;10(5):216-9. doi: http://dx.doi.org/10.13175/swjpcc067-15 PDF