Figure 3

Pleural effusion. Left and middle: minute pleural effusion at the PLAPS-point. Below the pleural line, a line regular and roughly parallel to the pleural line can be seen: the lung line, indicating the visceral pleura (arrows). This line, together with the pleural line and the shadow of the ribs, display a kind of quad: the quad sign. Right: M-mode shows a movement of the lung line (white arrows) toward the pleural line (black arrows) on inspiration—the sinusoid sign, indicating also a free pleural effusion, and a viscosity enabling the use of small caliper needle if thoracentesis is envisaged. E, expiration. Quantitative data: this effusion found at the PLAPS-point has an expiratory thickness of roughly 13 mm, i.e., an expectedly small volume (study in progress). A 15-mm distance is our minimum required for safe diagnostic or therapeutic puncture, allowing to simplify the problem of modeling the real volume of an effusion (Ref. 14). Extract from “Whole body ultrasonography in the critically ill” (2010 Ed, Chapter 15), with kind permission of Springer Science.