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


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


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?


The presence of a lung pulse excludes a pneumothorax 

crop Lung Pulse.gif

Do you see 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 not ruled out.

You have a POSSIBLE pneumothorax


Pneumothorax ruled out on that segment

NO PNUEMOTHORAX on the segment interrogated