Cineloop: Right longitudinal subcostal scan, liver and overlying hemidiaphragm visualized. Loss of normal mirror and curtain signs with crisp diaphragmatic surface and extension of the thoracic spine cephalad to costophrenic sulcus. Space above hemidiaphragm anechoic, with no plankton sign or septations, layers dependently.
Diagnosis: small to moderate right sided pleural effusion, adjacent lung atelectatic.
Smooth lung line visualized within anechoic space bordered by hemidiaphragm and spine, underlying lung lacks typical aeration artifacts and is of greater echogenicity than usual, dynamic respiratory excursion. 1-2 sub B-lines briefly visualized, no air/fluid bronchograms.
First image demonstrates the spine sign, with the translucent red line demarcating the anterior surface of the vertebral bodies.
Second image shows the sonographic landmarks for identification of the costophrenic sulcus (hemidiaphragm, thoracic spine) which is made visible by (asterisk) anechoic fluid.