Sonographic approach to dyspnea (mnemonic)

Last revised by David Carroll on 21 Apr 2019

This mnemonic will help with the sonographic approach to the critically ill patient with dyspnea:

  • CHEST

Mnemonic

  • C: collapsed lung (pneumothorax
  • H: heart failure (acute pulmonary edema)
    • diffuse bilateral anterior B lines associated with lung sliding 1
    • three or more B-lines per sonographic field garner the name "lung rockets"
      • the presence of lung rockets is highly suggestive of alveolar or interstitial edema
    • pleural line should appear thin and smooth
      • pleural thickening and/or irregularities may imply an inflammatory etiology to the edema
  • E: effusion (pericardial effusion
    • pericardial effusion appears as an anechoic space between the visceral and parietal pericardia
      • with the development of tamponade physiology one may also see right atrial systolic collapse, right ventricular diastolic collapse, a dilated and invariable inferior vena cava, and variation in the mitral inflow velocity >25% with spontaneous respiration 
  • S: sepsis (pneumonia)
    • air bronchograms/ B lines/subpleural consolidation 
    • fluid bronchograms/pleural effusion 
    • a collapsed inferior vena cava compatable with distributive shock and central venous hypovolemia may also be observed
  • T: thromboembolism (pulmonary embolism/deep vein thrombosis
    • PE: subpleural consolidation (size 0.5-3 cm) and right heart strain 
    • DVT: non-compressible vein in femoral or popliteal zone 2

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