Radiographic findings in eFAST

Radiographic findings in eFAST (Extended Focused Assessment with Sonography for Trauma) allow an emergency physician or a surgeon the ability to determine whether a patient has pneumothorax, hemothorax, pleural effusion, mass/tumor, or a lodged foreign body. The exam allows for visualization of the echogenic tissue, ribs, and lung tissue. Few radiographic signs are important in any trauma and they include the stratosphere sign, the sliding or seashore sign, and the sinusoid sign.

Stratosphere sign is a clinical medical ultrasound finding usually in an eFAST examination that can prove presence of a pneumothorax. The sign is an imaging finding using a 3.5–7.5 MHz ultrasound probe in the 4th and 5th intercostal spaces in the anterior clavicular line using the M-Mode of the machine. This finding is seen in the M-mode tracing as pleura and lung being indistinguishable as linear hyperechogenic lines and is fairly reliable for diagnosis of a pneumothorax. Even though the stratospheric sign can be an indication of pneumothorax its absence is not at all reliable to rule out pneumothorax as definitive diagnosis usually requires X-ray or CT of thorax.[1][2][3]

Seashore sign is another eFAST finding usually in the lungs in the M-mode that depicts the glandular echogenicity of the lung abutted by the linear appearance of the visceral pleura. This sign is a normal finding. In absence of a seashore sign or presence of a stratosphere sign, pneumothorax is likely. B-lines or "comet trails" are echogenic bright linear reflections beneath the pleura that are usually lost with any air between the probe and the lung tissue and therefore whose presence with seashore sign indicates absence of a pneumothorax.[1][3]

Sinusoid sign is another M-mode finding indicating presence of pleural effusion. Due to the cyclical movement of the lung in inspiration and expiration, the motion-time tracing (M-mode) ultrasound shows a sinusoid appearance between the fluid and the line tissue. This finding indicates possibly but not with certainty, of a pleural effusion, empyema, blood in pleural space (Hemothorax).[1][2]

Sources

  1. 1 2 3 Christopher P. Holstege; Alexander B. Baer; Jesse M. Pines; William J. Brady (2011). Visual Diagnosis in Emergency and Critical Care Medicine. Wiley-Blackwell. pp. 95–7.
  2. 1 2 Christoph T. Bolliger; F. J. F. Herth; P. Mayo; T. Miyazawa; J. Beamis (2009). Clinical chest ultrasound: from the ICU to the bronchoscopy suite. Karger Publishers. pp. 86–8.
  3. 1 2 Steven G. Rothrock (M.D.) (2009). Tarascon Adult Emergency Pocketbook. Tarascon. p. 144.

Further reading

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