All sonographers performing TFAST® should focus on learning the Big 3 – described in this FASTvet Blog.  See the FASTVet Video Library for many examples of Dry Lung, Wet Lung and Pneumothorax and the Search for the Lung Point (Lisciandro et al. JVECC 2008).

Dry LUNG

Fig. 1:  The first finding of the Big 3 at the TFAST® Chest Tube Site view in trauma for ruling out pneumothorax is the presence of the Glide Sign and A-lines.  The Glide Sign is the respirophasic synchrony of the “to and fro motion” of the “lung gliding” along the thoracic wall (Lisciandro et al, JVECC 2008; Lisciandro JVECC 2011).

Wet LUNG

Fig. 2: Wet Lung is the second major finding to be familiar with at the TFAST® Chest Tube Site. The respirophasic “to and fro” swinging motion of ultrasound lung rockets (also called B-lines) that must originate from the lung periphery and extend through the far field obliterating A-lines. These immediately rule out pneumothorax (PTX) at that level of the thorax, and in trauma are lung contusions until proven otherwise. Counting the number of ultrasound lung rockets (also called B-lines), using the Vet BLUE® ultrasound lung rocket (B-line) scoring system, maximum numberover a single intercostal space at each Vet BLUE ® lung region is a way to semi-quantitate or assign a Vet BLUE® lung contusion severity score (Lisciandro et al. JVECC 2008; Lisciandro, JVECC 2011).

Pneumothorax

Pneumothorax is the finding of A-lines WITHOUT the “Glide Sign” and the finding of the “Lung Point”, looking exactly like Fig. 1 but without the arrows along the pulmonary-pleural interface.

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