Figure 5. M-mode images with the low-frequency transducer. Left, the thoracostomy tube (TT) appears in transverse view as the anechoic circular structure with shadowing. When the cursor is placed lateral to the TT, a stratosphere sign is present. The visceral pleura is not well visualized. Right, when the cursor is placed over the TT, the black-out sign is seen.
Figure 4. M-mode images with the linear transducer. Left, the thoracostomy tube appears in transverse view as an anechoic circular structure with shadowing (double white arrow). With the cursor to the lateral aspect of the tube a stratosphere sign is present (indicating pneumothorax). The visceral pleura is also seen (thin white line). A pleural effusion can be seen just above the visceral pleura. Right, when the cursor is placed on top of the tube there is a distinct absence of waveform. We have named this the black-out sign.
Figure 3. Transverse (left) and longitudinal (right) views of the thoracostomy tube (TT) using the low-frequency transducer. Left, the TT is visualized in the upper portion of the screen as the anechoic circular structure with shadowing (white arrow). The pleural line and adjacent rib are not well visualized. Right, the TT is seen as it courses through the subcutaneous tissues and into the pleural space. The visceral pleura is also seen (thin blue arrow).
Figure 2. Left, transverse view of the thoracostomy tube (TT) using the linear transducer. The TT appears as a thinly curved echo with shadowing (double white arrow). A rib can be seen adjacent to the TT with a hyperechoic curved echo with shadowing (thick white arrow). In this image, a pleural effusion is also seen (thick short arrow) as well as the visceral pleura (thin white arrow). Right, longitudinal view of the TT using the linear transducer. The TT appears as a linear anechoic structure that courses through the subcutaneous tissues and into the pleural space (double white arrow). The visceral line is also seen (thin white arrow).
Figure 1. The thoracostomy tube (TT) was first identified in transverse and then longitudinal views by placing the transducer perpendicular to the TT insertion site (left) and then turning the transducer 90° to be parallel to the TT (right).
