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Pneumothorax Algorithm

The following is a concerted attempt at facilitating identification of patients with a pneumothorax.  To learn more about the theory behind the use of POCUS click here. By proceeding you accept the disclaimer of this algorithm  .


Start by ruling out a pneumothorax

B lines, Pleural line

Any one of the following images obtained using 2D or M mode excludes a pneumothorax on that segment 

crop pleural line.gif
NML M mode.png
crop B lines.gif

You are left with A lines on your scan and a possible pneumothorax

A lines

The presence of A lines is inconclusive for pneumo as other conditions also cause A lines. You need to confirm with other findings if possible.

Pleurodesis w chest tube ipsilateral.gif
Bar code sign.jpg

Do you see the image below?

Lung pulse

The presence of a lung pulse excludes a pneumothorax 

crop Lung Pulse.gif

Do you see Lung Point? 

Lung Point

Lung point is pathognomonic for pneumothorax. It is the transition between normal lung and air on the pleura. On the M- mode image you see the transition from barcode sign to seashore which confirms the diagnosis as well.

Lung point 02.gif
Lung point transition M mode.jpg

Pneumothorax confirmed


Pneumothorax ruled in

Pneumothorax not ruled out.

You have a POSSIBLE pneumothorax

Possible Pnuemotorax
Rule out Pneumo

Pneumothorax ruled out on that segment

NO PNUEMOTHORAX on the segment interrogated

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