Education  |   March 2019
B-lines Visualization and Lung Aeration Assessment: Mind the Ultrasound Machine Setting
Author Notes
  • From the Department of Anesthesia and Intensive Care, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia, Italy (S.M., A.O., F.M.); and the Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anesthesia and Intensive Care, University of Pavia, Pavia, Italy (A.S., A.O., F.M.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Address correspondence to Dr. Mongodi: silvia.mongodi@libero.it
Article Information
Education / Images in Anesthesiology / Radiological and Other Imaging / Respiratory System
Education   |   March 2019
B-lines Visualization and Lung Aeration Assessment: Mind the Ultrasound Machine Setting
Anesthesiology 3 2019, Vol.130, 444. doi:10.1097/ALN.0000000000002522
Anesthesiology 3 2019, Vol.130, 444. doi:10.1097/ALN.0000000000002522
Artifacts are important signs in lung ultrasound and provide information on the underlying lung density.1  A-lines are horizontal reverberation artifacts; B-lines are vertical hyperechoic laser-shaped artifacts. In the differential diagnosis of acute respiratory failure,2  three or more B-lines per scan define a B-pattern and suggest cardiogenic edema while ruling out chronic pulmonary obstructive disease decompensation and pneumothorax.2  Moreover, the number of B-lines progressively increases with lung density1 : a B-lines reduction indicates good response to antibiotics in ventilator-associated pneumonia or to positive end-expiratory pressure trial in adult respiratory distress syndrome; an increase in B-lines after fluid resuscitation is an early sign of overload.3  A correct visualization of B-lines and their number is therefore essential.