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Original Research

Open Access

Identification of lung sliding: a basic ultrasound technique with a steep learning curve


1,Medical Faculty University of Maribor

2,Faculty of Health Sciences University of Maribor

DOI: 10.22514/SV81.052013.5 Vol.8,Issue 1,May 2013 pp.31-35

Published: 01 May 2013

*Corresponding Author(s): MATEJ STRNAD E-mail:


Introduction. One of the basic premises of sonographic lung imaging is the concept of lung sliding. Identification of clear lung sliding excludes pneumothorax (PTx) at that specific local point.

Methods. Fifty-seven 4th year medical students were given a 20-minute lecture on sonographic identification of lung sliding and exclusion of PTx. After the lecture, students were asked to correctly position the probe, identify shown structures and on each attempt (six attempts in a row) state whether lung sliding is present or not.

Results. There were 57 students in the sample. Fifty students (87.7%) successfully positioned the probe (all 4 positions) for PTx identification. All but five students (91.2%) recognized the anatomic structures of the thorax. Mean number of correctly identified cases per student was 5.1 ± 1.1. In 292 (85.4%) cases, the answer was correct. In 298 (87.1%) cases, students were confident in the correct answer. Students who were confident in the right answer gave the right answer significantly more often when compared to others (90.3% vs. 52.3%, p < 0.001). Sensitivity of this method for 4th year medical students was 82.6% and its specificity was 87.9%. For correct identification of lung sliding in the sixth attempt, students on average needed 4.5 correct attempts.

Conclusion. Our study suggests that 4th year medical students with no prior experience in lung ultrasonography can easily acquire knowledge and skills needed to detect thoracic wall structures and identify lung sliding with a high degree of sensitivity and specificity. 


medical students, ultra-sonography, pneumothorax

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MATEJ STRNAD,SABINA ZADEL,ZALIKA KLEMENC-KETIS,GREGOR PROSEN . Identification of lung sliding: a basic ultrasound technique with a steep learning curve. Signa Vitae. 2013. 8(1);31-35.


1. Lichtenstein D. Ultrasound in the management of thoracic disease. Crit Care Med 2007;35:S250-61.

2. Sperandeo M, Filabozzi P, Varriale A, Carnevale V, Piattelli ML, Sperandeo G, et al. Role of thoracic ultrasound in the assessment of pleural and pulmonary diseases. J Ultrasound 2008;11:39-46.

3. Lichtenstein D, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill: Lung sliding. Chest 1995;108:1345–8.

4. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein D, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012;38:577-91.

5. Lyon M, Walton P, Bhalla V, Shiver SA. Ultrasound detection of the sliding lung sign by prehospital critical care providers. Am J Emerg Med 2012;30:485-8.

6. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH Exam: Rapid Ultrasound in Shock in the Evaluation of the Critically ill. Emerg Med Clin North Am 2010;28:39-56.

7. Rowan KR, Kirkpatrick AW, Liu D, Forkheim KE, Mayo JR, Nicolaou S. Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT – initial experience. Radiology 2002;225:210-4.

8. Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Gentiloni Silveri N. Occult Traumatic Pneumothorax: Diagnostic Accuracy of Lung Ultrasonography in the Emergency Department. Chest 2008;133:204-11.

9. Mennicke M, Gulati K, Oliva I, Goldflam K, Skali H, Ledbetter S, et al. Anatomical distribution of traumatic pneumothoraces on chest com-puted tomography: implications for ultrasound screening in the ED. Am J Emerg Med 2011;30:1025–31.

10. Lichtenstein D, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008;134:117-25.

11. Lichtenstein D, Meziere G, Biderman P, Gepner A. The ‘‘lung point’’: an ultrasound sign specific to pneumothorax. Intensive Care Med 2000;26:1434–40.

12. Zhang M, Liu ZH, Yang JX, Gan JX, Xu SW, You XD, et al. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Crit Care 2006;10:R112.

13. Lichtenstein D, Meziere G, Biderman P, Gepner A. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 1999;25:383-8.

14. Lichtenstein D, Lascols N, Prin S, Mezière G. The “lung pulse”: an early ultrasound sign of complete atelectasis. Intensive Care Med 2003;29:2187–92.

15. Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Margonato A, et al. “Ultrasound comet tail images”: A marker Of Pulmonary Edema: A Comparative Study With Wedge Pressure And Extravascular Lung Water. Chest 2005;127;1690-5.

16. Lichtenstein D, Mezière G, Biderman P, Gepner A, Barre O. The Comet-tail Artifact. An Ultrasound Sign of Alveolar-Interstitial Syndrome. Am J Respir Crit Care Med 1997;156:1640–6.

17. Parlamento S, Copetti R, Di Bartolomeo S. Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med 2009;27:379–84.

18. Reissig A, Heynes JP, Kroegel C. Sonography of lung and pleura in pulmonary embolism: sonomorphologic characterization and compa-rison with spiral CT scanning. Chest 2001;120:1977–83.

19. Volpicelli G, Caramello V, Cardinale L, Mussa A, Bar F, Frascisco MF. Bedside ultrasound of the lung for the monitoring of acute decom-pensated heart failure. Am J Emerg Med 2008;26:585–91.

20. Tsubo T, Sakai I, Suzuki A, Okawa H, Ishihara H, Matsuki A. Density detection in dependent left lung region using transesophageal echo-cardiography. Anesthesiology 2001;94:793–8.

21. Sim SS, Wan-Ching L, Chou HC, Chong KM, Liu SH, Wang CH, et al. Ultrasonographic lung sliding sign in confirming proper endotracheal intubation during emergency Intubation. Resuscitation 2012;83:307–12.

22. Breitkreutz R, Seibel A, Zechner PM. Ultrasound-guided evaluation of lung sliding for widespread use? Resuscitation 2012;83:273-4.

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