Whenever you are performing an E-FAST exam on your trauma patient or a thoracic US in those with unexplained shock or shortness of breath, your sphincter tightens when you see fluid in the belly or when there is no lung sliding. Ever placed your probe on the left anterior chest wall and have been surprised after noticing there is no lung sliding? Or, that you see this weird movement of “the lung” on the left side, which surely isn’t normal and definitely deeper than the pleural line and you think, “There’s a left pneumothorax!” Well, guess what guys and gals, it just could be the heart. The heart can get in the way of your view depending on the size of the thoracic cage of the patient or the placement of your linear probe on the anterior chest wall. If your probe is too low, you’ll see the heart…as seen below…. raise your probe higher and evaluate multiple rib spaces for confirmation.
For more talk on when the lung point is not the lung point – Go to 5MinSono here.
SonoSpot: Topics in Bedside Ultrasound 