POCUS - Lung Ultrasound: Understanding B Lines and Hepatization

This brief video explains why B lines are present on lung ultrasound and what pathology it represents. Additionally hepatization is explained.
Author: Jared T Marx MD
Lung ultrasound binary questions and videos:
1a - Is there lung sliding?
Video: • POCUS: Lung Ultrasound...
1b - If lung sliding is NOT present is there a lung point?
Video: • POCUS - Lung Ultrasoun...
2 -Are B lines (interstitial syndrome) present?
Video: • POCUS: Lung Ultrasound...
3 - Is the pleural line irregular?
Video: • POCUS: Lung Ultrasound...
4 - Is there hepatization (consolidation) of the lung? Video: • POCUS - Lung Ultrasoun...
5 - Is there free thoracic fluid? Video: Coming Soon
Important references:
International evidence-based recommendations for point-of-care lung ultrasound: link.springer....
This content is only meant for information and educational purposes only. This is NOT medical advice. The content does not substitute for professional medical advice and that no doctor-patient relationship is formed through the video. The Video Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health clinician with any questions you may have regarding a medical condition.

[@jonnbruin]

This was incredibly succinct and easy to comprehend! thank you for taking the time to make these diagrams as well

[@OOmmaaer]

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[@kimenyeabby.mugerwa4992]

Grateful for the video. It's informative and educative

[@fredastaire6156]

Dr. Marx, thank you so much for this video and your channel. (Writing to you from the future and currently taking a POCUS course at my University!)

[@parinlalwani4714]

Wonderful video, very nicely explained, Thanks

[@felmagarcia4320]

Thank you so much! Indeed a very helpful lecture !

[@MukeshJain-uw3hm]

Thanks for the nice video Can we get B lines in atelactasis

[@vivime1008]

Thank you, great video!

[@dr.farahnazkhan4817]

How should we scan lung anteriorly or posteriorly and longitudinal or transvarse plane which is best plz guide

[@TheGreatWall002]

Excellent video!!

[@laureneng6472]

how do you differentiate mirror artifact from hepatization?

[@POCUSGeek]

This can be difficult. Keep in mind that in order to have mirror artifact the ultrasound beam must travel through solid organ (or heart) before encountering the diaphragm (lung is where most mirror artifact occurs). If it occurs at the top of the screen, without passing through solid organ, then this is likely hepatization. Also you can look for the spine sign but this would require the entire lung lobe to have hepatization.

[@anotheraccount1391]

I'm confused here, Whats the difference between those B lines and a ring down artefact??

[@POCUSGeek]

B-lines is the name of this type of short path reverberation artifact that happens in the lung/aveoli. If it is in the bowel for example then it's called a ring down artifact (due to air/fluid in the bowel). Both are short path reverberation artifacts. Additionally there are long path reverberation artifacts. In the lung, for example, these are called A-lines. If it is created by a piece of metal, glass, or similar inside the body this would be a type of reverberation artifact that I've often heard people refer to this as ring down artifact (though this more likely reflects long path reverberation artifact). Does that help?

[@anotheraccount1391]

@@POCUSGeek yes. Thanks!

[@AhmedSalah-xe3md]

Thank you Your great

[@andrijsorenko2045]

Thank you so much

[@drmeghanabkulkarni9173]

Thank you sir

[@olitonottero7620]

love it

[@zahraajamal8601]

🙏🙏🙏

[@cecejordan3638]

How can you see lung cancer ?

[@POCUSGeek]

I'm not sure that this has been well defined and have limited experience as I often don't diagnosis this in the Emergency Department with ultrasound. Here are some characteristics that have been described but I am unaware of any well defined criteria. If that is your concern another imaging modality should be used. Malignant effusion - complex fluid (internal echoes) and/or complex effusions (septate effusion). Adjacent air bronchograms. Absence of lung sliding. An anything from well defined mass to a poorly defined mass. Keep in mind that if a cancer does not come in contact with the pleural line (where the visceral and parietal pleural come in contact) you won't be able to see the mass.

[@frank4282]

Bravu...

[@lisas6207]

👍