{"id":36299,"date":"2026-09-14T10:23:01","date_gmt":"2026-09-14T10:23:01","guid":{"rendered":"https:\/\/suresultmed.com\/?p=36299"},"modified":"2026-09-14T10:23:01","modified_gmt":"2026-09-14T10:23:01","slug":"pleural-effusion-ultrasound-images","status":"publish","type":"post","link":"https:\/\/suresultmed.com\/es\/pleural-effusion-ultrasound-images\/","title":{"rendered":"Pleural Effusion Ultrasound Images: Fluid, Atelectasis and the Diaphragm at the Lung Base"},"content":{"rendered":"<div class=\"sr-pe-2026\" data-suresult-article-root data-sr-author-voice=\"fernando-mariz-md jailyn-avila-md\">\n<style>body.postid-36299 .wd-page-title.post-title-large-image{background:#fff!important;color:#1b2426!important;min-height:0!important;height:auto!important;padding:44px 0 6px!important}\nbody.postid-36299 .wd-page-title.post-title-large-image .wd-page-title-bg{display:none!important}\nbody.postid-36299 .wd-page-title.post-title-large-image .wd-post-meta,body.postid-36299 .wd-page-title 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*{animation-duration:.001ms!important;animation-iteration-count:1!important;transition-duration:.001ms!important}}<\/style>\n<div class=\"sr-mast\">\n<p class=\"sr-deck\">Every thoracic frame this library holds for pleural fluid, in order: the finding first, then the same window with the air still in it, then collapsed lung drifting inside the collection. Six of the seven carry the depth, frequency and gain on their own screen.<\/p>\n<div class=\"sr-author-panel\" data-suresult-author-panel aria-label=\"Article authors\">\n<p class=\"sr-byline__label\">Written and clinically reviewed by<\/p>\n<div class=\"sr-author-grid\">\n<article class=\"sr-author-card\" data-sr-author=\"fernando-mariz-md\">\n<div class=\"sr-author-card__head\"><img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/fernando-mariz-md-author-avatar.png\" alt=\"Fernando Mariz, MD\" width=\"42\" height=\"42\" loading=\"lazy\" decoding=\"async\"><span class=\"sr-author-card__id\"><b>Fernando Mariz, MD<\/b><span class=\"sr-author-card__role\">Gynecology, pelvic surgery, sonography<\/span><\/span><\/div>\n<details data-sr-author-bio>\n<summary>About Dr. Mariz<\/summary>\n<p>I am Dr. Fernando Mariz, a gynecology and pelvic surgery physician practicing in New York City. Before my medical career, I served in the U.S. Marine Corps, where I developed the discipline, focus, and steadiness that continue to shape the way I care for patients today. At Maiden Lane Medical, my work covers women&rsquo;s health, preventive care, sonography, pelvic pain, abnormal uterine bleeding, and minimally invasive gynecologic procedures.<\/p>\n<p class=\"sr-author-card__links\"><a href=\"https:\/\/maidenlanemedical.com\/profile\/fernando-mariz-md\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Maiden Lane Medical profile<\/a> &middot; <a href=\"https:\/\/weillcornell.org\/fernando-marizmd-9639\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Weill Cornell Medicine<\/a><\/p>\n<\/details>\n<\/article>\n<article class=\"sr-author-card\" data-sr-author=\"jailyn-avila-md\">\n<div class=\"sr-author-card__head\"><img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/jailyn-avila-md-author-avatar.png\" alt=\"Jailyn Avila, MD\" width=\"42\" height=\"42\" loading=\"lazy\" decoding=\"async\"><span class=\"sr-author-card__id\"><b>Jailyn Avila, MD<\/b><span class=\"sr-author-card__role\">Emergency medicine, POCUS education<\/span><\/span><\/div>\n<details data-sr-author-bio>\n<summary>About Dr. Avila<\/summary>\n<p>I am Dr. Jailyn Avila, an emergency medicine physician, educator, and digital health innovator based in Southern California. My clinical work is rooted in emergency care, while my teaching focuses on point-of-care ultrasound, residency education, and practical training for physicians. Through my roles with Emergent Medical Associates, UHS SoCal MEC Emergency Medicine Residency, Core Ultrasound, and FemInEM, I work at the intersection of patient care, medical education, and accessible digital learning.<\/p>\n<p class=\"sr-author-card__links\"><a href=\"https:\/\/jailynavila.com\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Personal site<\/a> &middot; <a href=\"https:\/\/feminem.org\/about\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">FemInEM<\/a><\/p>\n<\/details>\n<\/article>\n<\/div>\n<p class=\"sr-author-meta\"><span class=\"sr-verified-badge\">Verified authors<\/span><span>Updated <b>September 14, 2026<\/b><\/span><\/p>\n<\/div>\n<\/div>\n<section id=\"quick-answer\">\n<h2>Quick answer<\/h2>\n<p><strong>A pleural effusion on ultrasound is a collection of fluid between the chest wall and the lung, sitting above the diaphragm, that returns no echo and lets the beam through where air normally stops it dead.<\/strong> The finding is that you can suddenly see structures at a depth where a normal chest shows only shadow. Thoracic ultrasound detects an effusion with a pooled sensitivity of 0.94 and a specificity of 0.98, against 0.51 and 0.91 for chest radiography. Collapsed lung inside the collection appears as a wedge of tissue density that drifts with respiration, because airless lung conducts sound instead of blocking it. Volume can be estimated from a single measurement, but the formula and the measurement travel together: <a href=\"https:\/\/europepmc.org\/article\/MED\/16432674\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">the Balik formula<\/a> multiplies the maximum separation between the two pleural surfaces at the lung base, measured supine at end expiration, by 20. Fluid on the abdominal side of the diaphragm is ascites, not effusion, and mistaking one for the other is the classic error on this exam. My own habit is to find the diaphragm before I look at anything dark, and to keep it in the frame while I decide.<\/p>\n<p class=\"sr-answer-note\">After the hardware instead of the exam? Chest probe choices sit on the <a href=\"https:\/\/suresultmed.com\/specialty\/handheld-ultrasound-for-pulmonology\/\">pulmonology hub<\/a>, and the <a href=\"https:\/\/suresultmed.com\/shop\/handheld-ultrasounds\/d3ultra-multipurpose-handheld-ultrasound\/\">D3Ultra product page<\/a> sets out what the head is specified to reach and what it sells for now.<\/p>\n<\/section>\n<section id=\"atlas\">\n<p class=\"sr-pe-krow\">Image atlas<\/p>\n<h2>Seven frames, the finding first<\/h2>\n<p>These are the thoracic recordings in the Scan Library for pleural fluid, in teaching order. Six of the seven carry the acquisition settings burned into their own panel, read off the screen rather than typed in afterwards, and six of the seven are shown exactly as the library holds them, at their own true size. Figure 6 is the exception on both counts: its export arrived with the parameter panel cropped away, and its caption says so. Figure 1 is the finding and figure 2 is the same window with the air still in it; if you only study two frames here, study that pair, because the second is what makes the first mean anything.<\/p>\n<p>Two limits, stated before the first image. Five of these seven recordings come from one study on 2018-03-19, made inside three minutes of one another, so they are five windows on one chest rather than five patients; the captions say which. And the device model was not recorded for any frame on this page, so none of them names one.<\/p>\n<figure class=\"sr-pe-fig\" id=\"fig-1\">\n<div class=\"sr-pe-frame\"><img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-effusion-ultrasound-fluid-above-diaphragm.jpg\" alt=\"Pleural effusion on ultrasound: dark fluid opening a window above the bright curved diaphragm with solid organ below, 5 MHz harmonic at 160 mm depth, gain 75 dB\" width=\"1781\" height=\"1293\" loading=\"lazy\" decoding=\"async\"><\/div><figcaption class=\"sr-pe-figcap\"><b>Figure 1. Fluid, and the window it opens.<\/b> The bright curved diaphragm runs across the lower sector with solid organ underneath it. Above it the beam is getting through instead of stopping, which is the whole finding. The control in figure 2 is a different patient on a different device in a different year, at 200 mm rather than 160, DR 60 rather than 80 and ENH 4 rather than 2 \u2014 which is the page\u2019s own thesis working on it: the settings change the picture, so both panels are printed under both frames.<\/figcaption><div class=\"sr-pe-set\">\n<p class=\"sr-pe-set__h\">Read off the screen<\/p>\n<ul class=\"sr-pe-spec\">\n<li><b>Device<\/b>\n<div class=\"sr-pe-spec__v\" data-sr-spec-table=\"1\">Suresult wireless convex probe (clinical reference library; model not recorded)<\/div>\n<\/li>\n<li><b>Recorded<\/b><span>2018-03-19 08:30:25 (on-screen clock)<\/span><\/li>\n<li><b>Panel<\/b><span>F H5.0 MHz \u00b7 D 160 mm \u00b7 GN 75 dB \u00b7 DR 80 \u00b7 ENH 2 \u00b7 frozen at 30\/30<\/span><\/li>\n<li><b>File<\/b><span>JPEG 1781 &times; 1293<\/span><\/li>\n<\/ul>\n<\/div>\n<\/figure>\n<figure class=\"sr-pe-fig\" id=\"fig-2\">\n<div class=\"sr-pe-frame\"><video controls preload=\"metadata\" playsinline poster=\"https:\/\/suresultmed.com\/wp-content\/uploads\/lung-base-aerated-no-fluid-ultrasound-cine-poster.jpg\" width=\"864\" height=\"656\" aria-label=\"Intercostal scan at the lung base with no fluid: a narrow bright band of chest wall and pleura with acoustic shadowing beneath it, 5 MHz harmonic at 200 mm depth, gain 83 dB\"><source src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/lung-base-aerated-no-fluid-ultrasound-cine.mp4\" type=\"video\/mp4\"><\/video><\/div><figcaption class=\"sr-pe-figcap\"><b>Figure 2. The lung base with nothing in it.<\/b> The same window with the air still in it, and it is mostly black on purpose. Air stops the beam at the pleural surface, so the screen shows a narrow wedge of chest wall and then shadow. The diaphragm, the liver and the spleen are behind that air and cannot be seen from here. Compare it with figure 1: fluid is what opens the window, and this is what the window looks like shut.<\/figcaption><div class=\"sr-pe-set\">\n<p class=\"sr-pe-set__h\">Read off the screen<\/p>\n<ul class=\"sr-pe-spec\">\n<li><b>Device<\/b>\n<div class=\"sr-pe-spec__v\" data-sr-spec-table=\"1\">Suresult wireless convex probe (clinical reference library; model not recorded)<\/div>\n<\/li>\n<li><b>Recorded<\/b><span>2017-01-07, frames stamped 12:11:53 to 12:12:40 (on-screen clock)<\/span><\/li>\n<li><b>Panel<\/b><span>F H5.0 MHz \u00b7 D 200 mm \u00b7 gain 83 dB \u00b7 DR 60 dB \u00b7 ENH 4 \u00b7 100 frame cine replay<\/span><\/li>\n<li><b>File<\/b><span>MP4 864 &times; 656 &middot; 10 s &middot; 100 frames<\/span><\/li>\n<\/ul>\n<\/div>\n<\/figure>\n<figure class=\"sr-pe-fig\" id=\"fig-3\">\n<div class=\"sr-pe-frame\"><video controls preload=\"metadata\" playsinline poster=\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-effusion-ultrasound-cine-poster.jpg\" width=\"480\" height=\"352\" aria-label=\"Pleural effusion cine on ultrasound showing dark fluid and echogenic strands moving above the diaphragm, 5 MHz harmonic at 160 mm depth, gain 86 dB\"><source src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-effusion-ultrasound-cine.mp4\" type=\"video\/mp4\"><\/video><\/div><figcaption class=\"sr-pe-figcap\"><b>Figure 3. The same chest, swept.<\/b> Gain is eleven decibels higher here than in the frozen frame above, and the fluid stops looking uniformly black: strands and moving echoes appear inside it. Turning gain up is how a collection that reads as simple starts to read as complex, which is why the number on the screen belongs in the record.<\/figcaption><div class=\"sr-pe-set\">\n<p class=\"sr-pe-set__h\">Read off the screen<\/p>\n<ul class=\"sr-pe-spec\">\n<li><b>Device<\/b>\n<div class=\"sr-pe-spec__v\" data-sr-spec-table=\"1\">Suresult wireless convex probe (clinical reference library; model not recorded)<\/div>\n<\/li>\n<li><b>Recorded<\/b><span>2018-03-19 08:33:17 to 08:33:24 (on-screen clock)<\/span><\/li>\n<li><b>Panel<\/b><span>F H5.0 MHz \u00b7 D 160 mm \u00b7 GN 86 dB \u00b7 DR 80 \u00b7 ENH 2 \u00b7 57 frame cine replay<\/span><\/li>\n<li><b>File<\/b><span>MP4 480 &times; 352 &middot; 5.7 s &middot; 57 frames<\/span><\/li>\n<\/ul>\n<\/div>\n<\/figure>\n<figure class=\"sr-pe-fig\" id=\"fig-4\">\n<div class=\"sr-pe-frame\"><img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/atelectatic-lung-in-pleural-fluid-ultrasound.jpg\" alt=\"Collapsed lung sitting inside pleural fluid on ultrasound, a tissue density wedge bounded by dark fluid and a bright curved diaphragm, 5 MHz harmonic at 160 mm depth\" width=\"1781\" height=\"1293\" loading=\"lazy\" decoding=\"async\"><\/div><figcaption class=\"sr-pe-figcap\"><b>Figure 4. Lung inside the fluid.<\/b> A wedge of tissue that looks like solid organ rather than air, bounded by dark fluid on one side and the bright curved diaphragm below. Airless lung conducts sound, so it draws with texture instead of stopping the beam. Frozen, it is a shape; it is the movement that names it.<\/figcaption><div class=\"sr-pe-set\">\n<p class=\"sr-pe-set__h\">Read off the screen<\/p>\n<ul class=\"sr-pe-spec\">\n<li><b>Device<\/b>\n<div class=\"sr-pe-spec__v\" data-sr-spec-table=\"1\">Suresult wireless convex probe (clinical reference library; model not recorded)<\/div>\n<\/li>\n<li><b>Recorded<\/b><span>2018-03-19 08:32:56 (on-screen clock)<\/span><\/li>\n<li><b>Panel<\/b><span>F H5.0 MHz \u00b7 D 160 mm \u00b7 GN 86 dB \u00b7 DR 80 \u00b7 ENH 2 \u00b7 cine replay, frame 100\/100<\/span><\/li>\n<li><b>File<\/b><span>JPEG 1781 &times; 1293<\/span><\/li>\n<\/ul>\n<\/div>\n<\/figure>\n<figure class=\"sr-pe-fig\" id=\"fig-5\">\n<div class=\"sr-pe-frame\"><video controls preload=\"metadata\" playsinline poster=\"https:\/\/suresultmed.com\/wp-content\/uploads\/atelectatic-lung-moving-in-pleural-fluid-cine-poster.jpg\" width=\"912\" height=\"672\" aria-label=\"Collapsed lung moving inside pleural fluid on ultrasound, the jellyfish sign, at 160 mm depth and gain 86 dB\"><source src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/atelectatic-lung-moving-in-pleural-fluid-cine.mp4\" type=\"video\/mp4\"><\/video><\/div><figcaption class=\"sr-pe-figcap\"><b>Figure 5. The same lung, moving.<\/b> The collapsed lobe drifts inside the collection as the chest moves. The literature calls this the jellyfish sign, and it is a B mode appearance; the M mode trace taken through the same space is a separate finding with its own name, the sinusoid sign. Watch the frequency on the panel as well: the operator runs 3.5 MHz for the first ten frames and switches to harmonic 5.0 MHz at frame 11.<\/figcaption><div class=\"sr-pe-set\">\n<p class=\"sr-pe-set__h\">Read off the screen<\/p>\n<ul class=\"sr-pe-spec\">\n<li><b>Device<\/b>\n<div class=\"sr-pe-spec__v\" data-sr-spec-table=\"1\">Suresult wireless convex probe (clinical reference library; model not recorded)<\/div>\n<\/li>\n<li><b>Recorded<\/b><span>2018-03-19 08:32:24 to 08:32:28 (on-screen clock)<\/span><\/li>\n<li><b>Panel<\/b><span>F 3.5 MHz for the first ten frames, then F H5.0 MHz from frame 11 \u00b7 D 160 mm \u00b7 GN 86 dB \u00b7 DR 80 \u00b7 ENH 2 \u00b7 38 frame cine replay<\/span><\/li>\n<li><b>File<\/b><span>MP4 912 &times; 672 &middot; 3.8 s &middot; 38 frames<\/span><\/li>\n<\/ul>\n<\/div>\n<\/figure>\n<figure class=\"sr-pe-fig\" id=\"fig-6\">\n<div class=\"sr-pe-frame\"><img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-effusion-atelectasis-second-study-ultrasound.jpg\" alt=\"Second ultrasound study showing pleural fluid with a curled edge of collapsed lung against the bright diaphragm\" width=\"590\" height=\"554\" loading=\"lazy\" decoding=\"async\"><\/div><figcaption class=\"sr-pe-figcap\"><b>Figure 6. A second patient, the same pattern.<\/b> The only frame on this page from a different study than the other effusion images. The curled tissue edge against the bright diaphragmatic line repeats what the first study shows, which is the point of including it. It is also the one frame here whose parameter panel was cropped out of the export, so its settings cannot be read off the screen the way the rest can.<\/figcaption><div class=\"sr-pe-set\">\n<p class=\"sr-pe-set__h\">Read off the screen<\/p>\n<ul class=\"sr-pe-spec\">\n<li><b>Device<\/b>\n<div class=\"sr-pe-spec__v\" data-sr-spec-table=\"1\">Suresult wireless convex probe (clinical reference library; model not recorded)<\/div>\n<\/li>\n<li><b>Recorded<\/b><span>a different study, on-screen clock 09:23:40; the date digits are cut off by the export<\/span><\/li>\n<li><b>Panel<\/b><span>Settings panel cropped out of this export; frequency, depth and gain are not legible<\/span><\/li>\n<li><b>File<\/b><span>JPEG 590 &times; 554<\/span><\/li>\n<\/ul>\n<\/div>\n<\/figure>\n<figure class=\"sr-pe-fig\" id=\"fig-7\">\n<div class=\"sr-pe-frame\"><video controls preload=\"metadata\" playsinline poster=\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-and-pericardial-effusion-ultrasound-cine-poster.jpg\" width=\"480\" height=\"352\" aria-label=\"Ultrasound cine logged as pleural effusion with a pericardial effusion in the same study, 5 MHz harmonic at 160 mm depth, gain 82 dB\"><source src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-and-pericardial-effusion-ultrasound-cine.mp4\" type=\"video\/mp4\"><\/video><\/div><figcaption class=\"sr-pe-figcap\"><b>Figure 7. Two compartments in one study.<\/b> Logged in the reference library as pleural fluid with a pericardial collection in the same examination. Which compartment a dark space belongs to is settled by the descending thoracic aorta: pericardial fluid tracks in front of it, pleural fluid behind and lateral to it. What this recording settles is that both compartments can fill in one patient, which is the reason the aorta is worth finding before the fluid is named.<\/figcaption><div class=\"sr-pe-set\">\n<p class=\"sr-pe-set__h\">Read off the screen<\/p>\n<ul class=\"sr-pe-spec\">\n<li><b>Device<\/b>\n<div class=\"sr-pe-spec__v\" data-sr-spec-table=\"1\">Suresult wireless convex probe (clinical reference library; model not recorded)<\/div>\n<\/li>\n<li><b>Recorded<\/b><span>2018-03-19 08:31:18 to 08:31:28 (on-screen clock)<\/span><\/li>\n<li><b>Panel<\/b><span>F H5.0 MHz \u00b7 D 160 mm \u00b7 GN 82 dB \u00b7 DR 80 \u00b7 ENH 2 \u00b7 49 frame cine replay<\/span><\/li>\n<li><b>File<\/b><span>MP4 480 &times; 352 &middot; 4.9 s &middot; 49 frames<\/span><\/li>\n<\/ul>\n<\/div>\n<\/figure>\n<p class=\"sr-pe-note\">These frames come from two devices with two panel layouts. The 2018 device writes its parameters in English as GN: and D:, and keeps \u51bb\u7ed3 for freeze and \u56de\u653e for cine replay: that is figures 1 and 3 to 7. The 2017 device writes the same two values in Chinese, \u589e\u76ca for gain and \u6df1\u5ea6 for depth: that is figure 2, the control. Every value that is legible is transcribed into the settings cards above in the usual notation. The on-screen ID, name, gender and age fields are the demonstration values the device ships with, and they are shown as recorded. Three further assets from the same library were reviewed and left out: two are down-scaled crops of frames already published above, and one is an overlapping export of the same cine buffer as figure 1.<\/p>\n<\/section>\n<section id=\"what-it-shows\">\n<p class=\"sr-pe-krow\">Reading the images<\/p>\n<h2>What this exam shows<\/h2>\n<p>One question, asked at one place. Put a low frequency curvilinear probe in a lower rib space in the mid to posterior axillary line, aim it at the diaphragm, and ask whether you can see past the pleura. In a chest with no fluid the answer is no: air reflects almost all of the beam, so the screen shows a couple of centimetres of chest wall and then shadow, and the diaphragm and the liver or spleen underneath it are invisible from that window. That is figure 1, and it is the reason this exam is quick to learn.<\/p>\n<p>Fluid changes the answer completely. A collection conducts sound, so the beam reaches the diaphragm and everything beyond it, and the image opens into a dark space bounded below by a bright curved line with solid organ under it. Inside that space, lung that has lost its air stops behaving like a mirror and starts behaving like tissue: it draws as a grey wedge with texture, tethered at the hilum, drifting as the chest moves.<\/p>\n<p>Two things the picture alone will not tell you. It will not tell you whether the fluid is transudate or exudate, because an anechoic collection can be either, and a concentrated transudate under diuretics can look echogenic. And it will not tell you which side of the diaphragm you are on unless you find the diaphragm first and keep it on screen, which is why the anchoring step is the whole technique.<\/p>\n<\/section>\n<section id=\"how\">\n<p class=\"sr-pe-krow\">Acquisition<\/p>\n<h2>How the scan is done<\/h2>\n<p>A low frequency curvilinear probe, <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9488781\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">2 to 5 MHz, penetrating 10 to 25 cm<\/a>, because an adult chest needs 10 to 25 cm of penetration. A phased array is an acceptable alternative for slipping between narrow rib spaces. A high frequency linear probe is the wrong tool here: it reaches 2 to 5 cm, which is the chest wall and the pleural surface, not the recess. Depth on the machine is commonly set to 8 to 10 cm.<\/p>\n<p><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9488781\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">The European Respiratory Review<\/a> describes the systematic examination as sitting the patient upright or leaning slightly forward and scanning from behind. For a supine patient, <a href=\"https:\/\/www.acep.org\/sonoguide\/basic\/lung\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">ACEP Sonoguide<\/a> puts the probe along the posterior axillary line above the diaphragm, because fluid is gravitationally dependent and pools in the costophrenic angle. That choice is not cosmetic: <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5035796\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Ko and colleagues<\/a> measured the pocket by approach in supine patients and found that in 40.6 percent of effusions the depth exceeded 1 cm posteriorly or posterolaterally but not laterally.<\/p>\n<p>Anchor the image before you interpret it. Find the diaphragm with the liver and right kidney below it on the right, or the spleen and left kidney on the left, and keep that landmark in the frame. Everything on the abdominal side of that line is abdomen. Then fan through the recess, and if a measurement is wanted, take the maximum separation between the two pleural surfaces at the base at end expiration and record the patient position alongside it, because the position changes which constant applies.<\/p>\n<p class=\"sr-pe-note\">On the safety question the evidence is one directional: a meta-analysis of 24 studies and 6605 procedures put the overall pneumothorax rate after thoracentesis at 6.0 percent and found imaging guidance associated with an odds ratio of 0.3.<\/p>\n<\/section>\n<section id=\"normal-abnormal\">\n<p class=\"sr-pe-krow\">Fast comparison<\/p>\n<h2>Fluid versus no fluid, structure by structure<\/h2>\n<p>Read the fourth column with the other three. On this exam the image is easy and the qualification is where the work is.<\/p>\n<div class=\"sr-table-wrap\">\n<table class=\"sr-pe-tbl\">\n<thead>\n<tr>\n<th>What you are looking at<\/th>\n<th>No fluid<\/th>\n<th>Fluid<\/th>\n<th>What the frame still cannot settle<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>\n<div class=\"sr-pe-cell\">Beyond the pleural surface<\/div>\n<\/td>\n<td>Air stops the beam. A narrow band of chest wall, then shadow, and nothing beyond it.<\/td>\n<td>The beam gets through. A dark space with recognisable structures visible behind it.<\/td>\n<td>A window says fluid is present. It does not say how much, and it does not say what the fluid is.<\/td>\n<\/tr>\n<tr>\n<td>\n<div class=\"sr-pe-cell\">The diaphragm<\/div>\n<\/td>\n<td>Not visible from an intercostal window over aerated lung.<\/td>\n<td>A bright curved line with liver or spleen immediately below it.<\/td>\n<td>Fluid on the abdominal side of that line is ascites. Getting the side wrong is the classic error on this exam.<\/td>\n<\/tr>\n<tr>\n<td>\n<div class=\"sr-pe-cell\">The lung edge<\/div>\n<\/td>\n<td>Not separately visible, because air and lung are one surface.<\/td>\n<td>A wedge of tissue density inside the collection that drifts as the chest moves.<\/td>\n<td>A frozen frame gives the shape. Only a clip gives the movement, and the movement is what names it.<\/td>\n<\/tr>\n<tr>\n<td>\n<div class=\"sr-pe-cell\">The fluid itself<\/div>\n<\/td>\n<td>No collection to characterise.<\/td>\n<td>Anechoic in a simple collection, echogenic or septated in a complex one.<\/td>\n<td>An anechoic collection can be transudate or exudate, and a concentrated transudate under diuretics can look echogenic.<\/td>\n<\/tr>\n<tr>\n<td>\n<div class=\"sr-pe-cell\">The depth of the pocket<\/div>\n<\/td>\n<td>No pocket to measure.<\/td>\n<td>The separation between parietal and visceral pleura at the base, in millimetres.<\/td>\n<td>The Balik multiplier of 20 is tied to this measurement in a supine patient. The sitting rule uses a different constant on a different distance, so the landmark and the position belong in the record with the number.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<p class=\"sr-table-note\">Echogenicity and what it predicts: <a href=\"https:\/\/europepmc.org\/article\/MED\/1609716\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Yang et al., 320 cases<\/a>, with the exception in <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9488781\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Hassan and colleagues<\/a>. The drifting collapsed lobe in B mode, and the sinusoid sign that the M mode trace through the same space produces: <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC12309786\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Killu and Kakol<\/a> and <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC3895677\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Lichtenstein<\/a>. Separating fluid above the diaphragm from fluid below it: <a href=\"https:\/\/europepmc.org\/article\/MED\/3536306\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Halvorsen and Thompson<\/a> and <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5081982\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Blanco and Volpicelli<\/a>. Volume formulas and the effect of patient position, each with the measurement it was derived on: <a href=\"https:\/\/europepmc.org\/article\/MED\/16432674\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Balik et al.<\/a> and <a href=\"https:\/\/europepmc.org\/article\/MED\/19903687\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Usta et al.<\/a>, read alongside <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC6344562\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Vetrugno and Bove<\/a>. All sources accessed September 14, 2026.<\/p>\n<\/section>\n<section id=\"device\">\n<p class=\"sr-pe-krow\">Hardware<\/p>\n<h2>Device and settings<\/h2>\n<p class=\"sr-choice\">The left column is the published specification; the right column is what the device interface actually showed while these frames were acquired. Look at the depth first. Every frame whose panel is legible ran at 160 or 200 mm, which is a convex-array setting, and it is the single fact that decides the hardware for this exam. A high frequency linear probe is not a good fit for this window at any price: it cannot reach an adult costophrenic recess and no amount of gain repairs that. That depth line is what I would buy on. If chest and abdominal work is the whole job, the convex-only probe below reaches the same depth for less. A head that carries three geometries starts to earn its price only once lines, joints and small parts are on the same list.<\/p>\n<div class=\"sr-pe-dev\">\n<div class=\"sr-pe-dev__grid\">\n<div class=\"sr-pe-dev__col\" data-sr-spec-table=\"1\">\n<p class=\"sr-pe-dev__h\">Published specification<\/p>\n<p class=\"sr-pe-dev__name\">Suresult D3Ultra<\/p>\n<p class=\"sr-pe-dev__price\">Three geometries, one head &mdash; {{SRX_PRICE:28571}}<\/p>\n<ul class=\"sr-pe-spec\">\n<li><b>Convex<\/b><span>3.2 \/ 5.0 MHz &middot; 90&ndash;300 mm &middot; 45&deg;<\/span><\/li>\n<li><b>Phased<\/b><span>3.2 \/ 5.0 MHz &middot; 90&ndash;300 mm &middot; 60&deg;<\/span><\/li>\n<li><b>Linear<\/b><span>7.5 \/ 10 MHz &middot; 20&ndash;100 mm &middot; 40 mm<\/span><\/li>\n<li><b>Signal path<\/b><span>192 elements &middot; 64 channels &middot; 256 grey levels<\/span><\/li>\n<li><b>Gain range<\/b><span>30&ndash;105 dB &middot; dynamic range 40&ndash;110<\/span><\/li>\n<li><b>Doppler<\/b><span>Colour, Power and PW, alongside B and M<\/span><\/li>\n<li><b>Handpiece<\/b><span>156 &times; 65 &times; 20 mm &middot; 263 g &middot; 2 h scanning<\/span><\/li>\n<li><b>Connects to<\/b><span>iOS, Android, Windows &middot; dual-band Wi-Fi<\/span><\/li>\n<\/ul>\n<\/div>\n<div class=\"sr-pe-dev__col\">\n<p class=\"sr-pe-dev__h\">Read off the screens, across the six legible panels<\/p>\n<ul class=\"sr-pe-spec\">\n<li><b>Preset<\/b><span>Not displayed on these frames<\/span><\/li>\n<li><b>Array<\/b><span>Convex on every frame<\/span><\/li>\n<li><b>Depth<\/b><span>D 160 mm on the effusion study, D 200 mm on the control; not legible on figure 6<\/span><\/li>\n<li><b>Frequency<\/b><span>F 3.5 MHz and F H5.0 MHz<\/span><\/li>\n<li><b>Gain<\/b><span>GN 75 to 86 dB across the six legible panels<\/span><\/li>\n<li><b>Dynamic range<\/b><span>DR 60 and DR 80 &middot; ENH 2 and 4<\/span><\/li>\n<li><b>Output<\/b><span>MI and TIS not displayed on these frames<\/span><\/li>\n<li><b>Modes<\/b><span>B mode throughout &middot; every finding here is settled in grey scale<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"sr-pe-dev__links\"><a href=\"https:\/\/suresultmed.com\/shop\/handheld-ultrasounds\/d3ultra-multipurpose-handheld-ultrasound\/\">D3Ultra specification and price &rarr;<\/a><a href=\"https:\/\/suresultmed.com\/shop\/handheld-ultrasounds\/c5sh-64-channels-high-res-convex-ultrasound-probe-color-doppler\/\">C5SH convex probe &mdash; {{SRX_PRICE:28591}} &rarr;<\/a><a href=\"https:\/\/suresultmed.com\/specialty\/handheld-ultrasound-for-pulmonology\/\">Pulmonology hub &rarr;<\/a><a href=\"https:\/\/suresultmed.com\/specialty\/handheld-ultrasound-for-critical-care\/\">Critical care hub &rarr;<\/a><a href=\"https:\/\/suresultmed.com\/suresult-video-library\/\">Scan Library &rarr;<\/a><\/div>\n<\/div>\n<p class=\"sr-pe-hublink\">The abdominal half of the same probe and the same depth setting is covered on the <a href=\"https:\/\/suresultmed.com\/gallbladder-ultrasound-images\/\">gallbladder and right upper quadrant image atlas<\/a>.<\/p>\n<\/section>\n<section id=\"related\">\n<p class=\"sr-pe-krow\">Same probe, other windows<\/p>\n<h2>Related scans<\/h2>\n<div class=\"sr-pe-rels\"><a class=\"sr-pe-rel\" href=\"https:\/\/suresultmed.com\/b-lines-lung-ultrasound-blue-protocol\/\"><span class=\"sr-pe-rel__img\"><img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/lung-ultrasound-pleural-line-m-mode-poster.jpg\" alt=\"Chest wall and pleural line in B mode with an M mode strip below it on a handheld probe\" width=\"1920\" height=\"1080\" loading=\"lazy\" decoding=\"async\"><\/span><span class=\"sr-pe-rel__b\"><span class=\"sr-pe-rel__t\">B-lines and the BLUE protocol, narrated<\/span><span class=\"sr-pe-rel__d\">The sibling chest page: the pleural line itself, the four points, and the artefacts that come off it, with a full transcript.<\/span><span class=\"sr-pe-rel__cta\">Open<\/span><\/span><\/a><a class=\"sr-pe-rel\" href=\"https:\/\/suresultmed.com\/efast-exam-handheld-ultrasound\/\"><span class=\"sr-pe-rel__img\"><img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/efast-exam-right-upper-quadrant-poster.jpg\" alt=\"Right upper quadrant view on a handheld convex probe during an eFAST walkthrough\" width=\"1280\" height=\"720\" loading=\"lazy\" decoding=\"async\"><\/span><span class=\"sr-pe-rel__b\"><span class=\"sr-pe-rel__t\">The eFAST exam, narrated<\/span><span class=\"sr-pe-rel__d\">The trauma protocol that also asks whether there is fluid above the diaphragm, with all four windows.<\/span><span class=\"sr-pe-rel__cta\">Open<\/span><\/span><\/a><a class=\"sr-pe-rel\" href=\"https:\/\/suresultmed.com\/suresult-video-library\/\"><span class=\"sr-pe-rel__img\"><img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/rib-short-axis-cortex-shadow-poster.jpg\" alt=\"Short axis rib view on a handheld probe with acoustic shadowing beneath the cortex\" width=\"1300\" height=\"947\" loading=\"lazy\" decoding=\"async\"><\/span><span class=\"sr-pe-rel__b\"><span class=\"sr-pe-rel__t\">The whole Scan Library<\/span><span class=\"sr-pe-rel__d\">The rest of the clinical recordings Suresult holds, sortable by anatomy and by probe.<\/span><span class=\"sr-pe-rel__cta\">Open<\/span><\/span><\/a><\/div>\n<p class=\"sr-pe-hublink\">Everything else the library holds is in the <a href=\"https:\/\/suresultmed.com\/suresult-video-library\/\">Scan Library<\/a>, sortable by anatomy and by probe.<\/p>\n<\/section>\n<section id=\"faq\">\n<p class=\"sr-pe-krow\">Asked on this search<\/p>\n<h2>Pleural effusion ultrasound questions<\/h2>\n<div class=\"sr-faq sr-pe-faq\">\n<details class=\"sr-pe-q\">\n<summary>Can ultrasound detect a pleural effusion better than a chest radiograph?<\/summary>\n<p>Yes, and the gap is wide. A meta-analysis of 12 studies covering 1554 subjects put pooled sensitivity at 0.94 and specificity at 0.98 for ultrasound, against 0.51 and 0.91 for radiography. In ventilated intensive care patients scanned against CT as the reference, ultrasound reached 100 percent sensitivity and specificity while the bedside film managed 65 and 81 percent.<\/p>\n<\/details>\n<details class=\"sr-pe-q\">\n<summary>How small a pleural effusion can ultrasound find?<\/summary>\n<p>Very small. The original comparative study showed ultrasound detecting as little as 3 to 5 mL of loculated pleural fluid, and a study of healthy volunteers measured normal fluid layers of 2.0 to 4.3 mm. A plain film is far blunter: fluid becomes visible as a meniscus on the lateral view at roughly 50 mL and on the frontal view at roughly 200 mL.<\/p>\n<\/details>\n<details class=\"sr-pe-q\">\n<summary>How is pleural effusion volume measured on ultrasound?<\/summary>\n<p>The usual shortcut is the Balik formula: volume in millilitres equals 20 multiplied by the maximum separation between the parietal and visceral pleura in millimetres, measured at the lung base at end expiration. It was derived in 81 ventilated patients lying supine with the trunk raised 15 degrees, and its mean prediction error is 158 plus or minus 161 mL. A separate rule exists for the sitting patient, from Usta and colleagues in cardiac surgery, but it multiplies by 16 and it measures a different distance, from the mid height of the diaphragm to the visceral pleura. The two constants are not interchangeable on one measurement.<\/p>\n<\/details>\n<details class=\"sr-pe-q\">\n<summary>What can be mistaken for a pleural effusion on ultrasound?<\/summary>\n<p>Three things. Fluid below the diaphragm, which is ascites, and the diaphragm sign, the displaced crus sign and the bare area sign are what separate them. A mirror artefact, which repeats the liver pattern above the diaphragm because the diaphragm is a strongly reflective surface. And a pericardial collection, which has been documented reproducing the appearance of a collapsed lung floating in fluid.<\/p>\n<\/details>\n<details class=\"sr-pe-q\">\n<summary>How do you tell a pericardial effusion from a pleural effusion?<\/summary>\n<p>By where the fluid sits relative to the descending thoracic aorta. The original echocardiographic series showed that isolated pericardial fluid produced an echo free space between the descending thoracic aorta and the posterior wall of the left ventricle, while isolated pleural fluid produced a space behind that aorta. Point of care teaching states the same rule: pericardial fluid tracks in front of the descending aorta, pleural fluid behind and lateral to it.<\/p>\n<\/details>\n<\/div>\n<\/section>\n<section id=\"sources\">\n<p class=\"sr-pe-krow\">Provenance<\/p>\n<h2>Sources and image provenance<\/h2>\n<ul class=\"sr-pe-src\">\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4744606\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Yousefifard M, Baikpour M, Ghelichkhani P, et al. Screening performance characteristic of ultrasonography and radiography in detection of pleural effusion. Archives of Academic Emergency Medicine, 2016<\/a><span>The pooled sensitivity and specificity of ultrasound and of chest radiography across 12 studies and 1554 subjects. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/europepmc.org\/article\/MED\/21809107\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Xirouchaki N, Magkanas E, Vaporidi K, et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Medicine, 2011<\/a><span>The head-to-head accuracy against CT in ventilated patients, 84 hemithoraces. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/europepmc.org\/article\/MED\/1277928\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Gryminski J, Krakowka P, Lypacewicz G. The diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest, 1976<\/a><span>The original demonstration that ultrasound resolves a few millilitres of loculated pleural fluid. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/europepmc.org\/article\/MED\/15351248\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Kocijancic I, Kocijancic K, Cufer T. Imaging of pleural fluid in healthy individuals. Clinical Radiology, 2004<\/a><span>The measured thickness of the physiological fluid layer in healthy volunteers, which is why a trace layer is not automatically a finding. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/europepmc.org\/article\/MED\/8796649\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Blackmore CC, Black WC, Dallas RV, Crow HC. Pleural fluid volume estimation: a chest radiograph prediction rule. Academic Radiology, 1996<\/a><span>The volumes at which fluid becomes visible on lateral and frontal radiographs. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/europepmc.org\/article\/MED\/16432674\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Balik M, Plasil P, Waldauf P, et al. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Medicine, 2006<\/a><span>The volume formula, the measurement it needs, the patient position it was derived in, and its prediction error. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/europepmc.org\/article\/MED\/19903687\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Usta E, Mustafi M, Ziemer G. Ultrasound estimation of volume of postoperative pleural effusion in cardiac surgery patients. Interactive CardioVascular and Thoracic Surgery, 2010<\/a><span>The different constant that applies when the patient is sitting. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC6344562\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Vetrugno L, Bove T. Lung ultrasound estimation of pleural effusion fluid and the importance of patient position. Annals of Intensive Care, 2018<\/a><span>Where the volume formula drifts, and why trunk elevation changes the answer. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/europepmc.org\/article\/MED\/1609716\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Yang PC, Luh KT, Chang DB, et al. Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. American Journal of Roentgenology, 1992<\/a><span>What echogenicity does and does not predict about the nature of the fluid. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9488781\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Hassan M, Mercer RM, Rahman NM. Thoracic ultrasound in the modern management of pleural disease. European Respiratory Review, 2020<\/a><span>Probe class, frequency range and achievable depth, the anchoring step of the scan, the patient position, and the exception to the echogenicity rule. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC12309786\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Killu K, Kakol M. Practical applications of lung and diaphragm ultrasound in the intensive care unit: an updated narrative review. Cureus, 2025<\/a><span>The description of the collapsed lung moving inside the collection, the name of the M mode waveform taken through the same space, and the depth setting used in practice. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC3895677\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Lichtenstein DA. Lung ultrasound in the critically ill. Annals of Intensive Care, 2014<\/a><span>The authoritative definition of the M mode waveform and what it implies about the viscosity of the fluid. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/europepmc.org\/article\/MED\/3536306\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Halvorsen RA, Thompson WM. Ascites or pleural effusion? CT and ultrasound differentiation. Critical Reviews in Diagnostic Imaging, 1986<\/a><span>That the two are genuinely confusable, and the three named signs that separate them. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5081982\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Blanco P, Volpicelli G. Common pitfalls in point-of-care ultrasound: a practical guide for emergency and critical care physicians. Critical Ultrasound Journal, 2016<\/a><span>The mirror artefact above the diaphragm, the falciform ligament as a positive identifier of ascites, and the modern statement of the descending-aorta rule. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/europepmc.org\/article\/MED\/6449141\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Haaz WS, Mintz GS, Kotler MN, Parry W, Segal BL. Two dimensional echocardiographic recognition of the descending thoracic aorta. American Journal of Cardiology, 1980<\/a><span>The original source of the descending-aorta discriminator between pericardial and pleural fluid. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/europepmc.org\/article\/MED\/33768495\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Montero-Yeboles R, Arroyo-Marin MJ, Jaraba-Caballero S, et al. A pleural ultrasound image of a collapsed lung surrounded by pleural fluid may correspond to an intrapericardial mass. Journal of Ultrasound, 2022<\/a><span>The documented case in which a pericardial collection reproduced the floating-lung appearance. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5035796\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Ko JM, Kim J, Park SA, et al. Depth of pleural effusion in thoracentesis: comparison of lateral, posterolateral and posterior approaches in the supine position. Iranian Journal of Radiology, 2016<\/a><span>Why a posterior or posterolateral window finds a deeper pocket than a lateral one in a supine adult. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/europepmc.org\/article\/MED\/20177035\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Archives of Internal Medicine, 2010<\/a><span>The pooled pneumothorax rate across 6605 procedures and the effect of imaging guidance. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/www.acep.org\/sonoguide\/basic\/lung\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">American College of Emergency Physicians. Sonoguide: Lung<\/a><span>The probe choice and the scan line above the diaphragm in both the upright and the supine patient. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/suresultmed.com\/shop\/handheld-ultrasounds\/d3ultra-multipurpose-handheld-ultrasound\/\">Suresult. D3Ultra convex, linear and phased handheld ultrasound, product page<\/a><span>The published specification column in the device card, and the current price. Accessed September 14, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/suresultmed.com\/shop\/handheld-ultrasounds\/c5sh-64-channels-high-res-convex-ultrasound-probe-color-doppler\/\">Suresult. C5SH 64-channel convex ultrasound probe with colour Doppler, product page<\/a><span>The published specification and the current price of the convex-only alternative. Accessed September 14, 2026.<\/span><\/li>\n<\/ul>\n<p class=\"sr-pe-note\">Every frame on this page was recorded by Suresult&rsquo;s own 2017 to 2020 clinical reference library. Nothing comes from a third-party image bank. The device model was not recorded for any of them and they predate the current product line, so no frame here is attributed to a current model. Six of the seven carry a legible parameter panel, and those settings are transcribed from the frame&rsquo;s own burned-in display. The finding labels are the labels the library itself recorded. No frame has been retouched or relabelled. One is cropped, and its caption says so: figure 6 reached the library as an export with the parameter panel and the date digits cut away.<\/p>\n<\/section>\n<div class=\"sr-final-cta\">\n<div class=\"sr-choice\">\n<h2>How deep does your chest work actually have to reach?<\/h2>\n<p>An adult costophrenic recess is a deep target approached between ribs, so the answer starts by ruling a high frequency linear array out rather than in. What is left open is whether one head also has to cover lines, joints and small parts. Say what a normal week on your list looks like and I will tell you which of those depths actually decides it, up to and including the case for buying nothing yet.<\/p>\n<\/div>\n<div class=\"sr-chat-link\">\n<button class=\"sr-crisp-consult-btn\" type=\"button\" data-sr-crisp-open onclick=\"window.$crisp=window.$crisp||[];window.$crisp.push(['do','chat:open']);\">ONLINE EXPERT CONSULT<\/button>\n<\/div>\n<\/div>\n<nav id=\"sr-pe-toc\" class=\"sr-light-toc sr-sticky-toc sr-article-toc\" data-suresult-toc data-sr-hide-on-wide-table aria-label=\"Pleural effusion image atlas navigation\">\n<div class=\"sr-light-toc__head\">\n<div class=\"sr-light-toc__title\">On this page<\/div>\n<p><span class=\"sr-light-toc__progress\" id=\"sr-pe-progress\">0%<\/span><\/div>\n<div class=\"sr-light-toc__links\"><a href=\"#quick-answer\">Quick answer<\/a><a href=\"#atlas\">Image atlas<\/a><a href=\"#what-it-shows\">What it shows<\/a><a href=\"#how\">How the scan is done<\/a><a href=\"#normal-abnormal\">Fluid \/ no fluid<\/a><a href=\"#device\">Device and settings<\/a><a href=\"#related\">Related scans<\/a><a href=\"#faq\">FAQ<\/a><a href=\"#sources\">Sources<\/a><\/div>\n<p class=\"sr-light-toc__note\">Not sure which probe your chest work needs?<\/p>\n<p><button class=\"sr-crisp-consult-btn\" type=\"button\" data-sr-crisp-open onclick=\"window.$crisp=window.$crisp||[];window.$crisp.push(['do','chat:open']);\">ONLINE EXPERT CONSULT<\/button><br \/>\n<\/nav>\n<p><script>(function(){\nvar toc=document.getElementById('sr-pe-toc');\nif(toc){\nvar links=[].slice.call(toc.querySelectorAll('a[href^=\"#\"]'));\nvar secs=[];\nlinks.forEach(function(a){\nvar id=a.getAttribute('href').slice(1);\nvar el=document.getElementById(id);\nif(el){secs.push(el);}\n});\nwindow.__srPeSpy=function(){\nif(!links.length){return;}\nvar line=window.innerHeight*0.28;\nvar idx=0;\nfor(var i=0;i<secs.length;i++){\nif(secs[i].getBoundingClientRect().top<=line){idx=i;}\n}\nlinks.forEach(function(l){l.classList.remove('sr-toc-active');});\nlinks[idx].classList.add('sr-toc-active');\n};\nif(window.IntersectionObserver){\nvar io=new IntersectionObserver(function(){window.__srPeSpy();},{rootMargin:'-12% 0px -72% 0px'});\nsecs.forEach(function(s){io.observe(s);});\n}\nwindow.__srPeSpy();\n}\nvar pr=document.getElementById('sr-pe-progress');\nvar tick=false;\nfunction upd(){\ntick=false;\nif(window.__srPeSpy){window.__srPeSpy();}\nvar h=document.documentElement;\nvar m=h.scrollHeight-h.clientHeight;\nvar v=m>0?Math.round(h.scrollTop\/m*100):0;\nif(pr){pr.textContent=v+'%';}\n}\nwindow.addEventListener('scroll',function(){\nif(tick){return;}\ntick=true;\nrequestAnimationFrame(upd);\n},{passive:true});\nupd();\nvar vids=[].slice.call(document.querySelectorAll('.sr-pe-frame video'));\nvids.forEach(function(v){\nv.addEventListener('play',function(){\nvids.forEach(function(o){\nif(o!==v){o.pause();}\n});\n});\n});\n})();<\/script><br \/>\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#webpage\",\"url\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/\",\"name\":\"Pleural Effusion Ultrasound Images: Fluid and Lung\",\"description\":\"Fluid opening a window above the diaphragm, collapsed lung floating inside it and an empty chest for contrast, with the settings read off the screen.\",\"inLanguage\":\"en-US\",\"isPartOf\":{\"@id\":\"https:\/\/suresultmed.com\/#website\"},\"breadcrumb\":{\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#breadcrumb\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#figure-1\"}},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/suresultmed.com\/#website\",\"url\":\"https:\/\/suresultmed.com\/\",\"name\":\"Suresult\",\"publisher\":{\"@type\":\"Organization\",\"@id\":\"https:\/\/suresultmed.com\/#suresult-merchant\",\"name\":\"Suresult\",\"url\":\"https:\/\/suresultmed.com\/\"}},{\"@type\":\"Article\",\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#article\",\"headline\":\"Pleural Effusion Ultrasound Images: Fluid, Atelectasis and the Diaphragm at the Lung Base\",\"description\":\"Every thoracic frame in the Suresult Scan Library for pleural fluid: fluid opening a window above the diaphragm, an intercostal window with no fluid in it for contrast, collapsed lung drifting inside the collection, and a study with fluid in two compartments. Six of the seven carry the depth, transmit frequency and gain burned into their own panel.\",\"datePublished\":\"2026-09-14\",\"dateModified\":\"2026-09-14\",\"inLanguage\":\"en-US\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#webpage\"},\"image\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-effusion-ultrasound-images-cover.jpg\",\"author\":[{\"@type\":\"Person\",\"@id\":\"https:\/\/suresultmed.com\/#fernando-mariz-md\",\"name\":\"Fernando Mariz, MD\",\"jobTitle\":\"Gynecology and pelvic surgery physician\",\"url\":\"https:\/\/maidenlanemedical.com\/profile\/fernando-mariz-md\/\",\"image\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/fernando-mariz-md-author-avatar.png\",\"sameAs\":[\"https:\/\/weillcornell.org\/fernando-marizmd-9639\",\"https:\/\/suresultmed.com\/author\/dr-fernando-mariz-md\/\"],\"knowsAbout\":[\"Gynecology\",\"Pelvic surgery\",\"Sonography\",\"Point-of-care ultrasound\"]},{\"@type\":\"Person\",\"@id\":\"https:\/\/suresultmed.com\/#jailyn-avila-md\",\"name\":\"Jailyn Avila, MD\",\"jobTitle\":\"Emergency medicine physician and POCUS educator\",\"url\":\"https:\/\/jailynavila.com\/\",\"image\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/jailyn-avila-md-author-avatar.png\",\"sameAs\":[\"https:\/\/feminem.org\/about\"],\"knowsAbout\":[\"Emergency medicine\",\"Point-of-care ultrasound\",\"Residency education\"]}],\"publisher\":{\"@type\":\"Organization\",\"@id\":\"https:\/\/suresultmed.com\/#suresult-merchant\",\"name\":\"Suresult\",\"url\":\"https:\/\/suresultmed.com\/\"},\"about\":{\"@type\":\"MedicalTest\",\"name\":\"Thoracic ultrasound for pleural effusion\"},\"keywords\":\"pleural effusion ultrasound images, pleural effusion ultrasound, thoracic ultrasound, pleural fluid, atelectasis ultrasound, pleural effusion volume, POCUS\"},{\"@type\":\"FAQPage\",\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#faq\",\"mainEntity\":[{\"@type\":\"Question\",\"name\":\"Can ultrasound detect a pleural effusion better than a chest radiograph?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes, and the gap is wide. A meta-analysis of 12 studies covering 1554 subjects put pooled sensitivity at 0.94 and specificity at 0.98 for ultrasound, against 0.51 and 0.91 for radiography. In ventilated intensive care patients scanned against CT as the reference, ultrasound reached 100 percent sensitivity and specificity while the bedside film managed 65 and 81 percent.\"}},{\"@type\":\"Question\",\"name\":\"How small a pleural effusion can ultrasound find?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Very small. The original comparative study showed ultrasound detecting as little as 3 to 5 mL of loculated pleural fluid, and a study of healthy volunteers measured normal fluid layers of 2.0 to 4.3 mm. A plain film is far blunter: fluid becomes visible as a meniscus on the lateral view at roughly 50 mL and on the frontal view at roughly 200 mL.\"}},{\"@type\":\"Question\",\"name\":\"How is pleural effusion volume measured on ultrasound?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The usual shortcut is the Balik formula: volume in millilitres equals 20 multiplied by the maximum separation between the parietal and visceral pleura in millimetres, measured at the lung base at end expiration. It was derived in 81 ventilated patients lying supine with the trunk raised 15 degrees, and its mean prediction error is 158 plus or minus 161 mL. A separate rule exists for the sitting patient, from Usta and colleagues in cardiac surgery, but it multiplies by 16 and it measures a different distance, from the mid height of the diaphragm to the visceral pleura. The two constants are not interchangeable on one measurement.\"}},{\"@type\":\"Question\",\"name\":\"What can be mistaken for a pleural effusion on ultrasound?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Three things. Fluid below the diaphragm, which is ascites, and the diaphragm sign, the displaced crus sign and the bare area sign are what separate them. A mirror artefact, which repeats the liver pattern above the diaphragm because the diaphragm is a strongly reflective surface. And a pericardial collection, which has been documented reproducing the appearance of a collapsed lung floating in fluid.\"}},{\"@type\":\"Question\",\"name\":\"How do you tell a pericardial effusion from a pleural effusion?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"By where the fluid sits relative to the descending thoracic aorta. The original echocardiographic series showed that isolated pericardial fluid produced an echo free space between the descending thoracic aorta and the posterior wall of the left ventricle, while isolated pleural fluid produced a space behind that aorta. Point of care teaching states the same rule: pericardial fluid tracks in front of the descending aorta, pleural fluid behind and lateral to it.\"}}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/suresultmed.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Scan Library\",\"item\":\"https:\/\/suresultmed.com\/suresult-video-library\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Pleural effusion ultrasound images\",\"item\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/\"}]},{\"@type\":\"ImageObject\",\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#figure-1\",\"contentUrl\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-effusion-ultrasound-fluid-above-diaphragm.jpg\",\"url\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-effusion-ultrasound-fluid-above-diaphragm.jpg\",\"caption\":\"Fluid, and the window it opens. The bright curved diaphragm runs across the lower sector with solid organ underneath it. Above it the beam is getting through instead of stopping, which is the whole finding. The control in figure 2 is a different patient on a different device in a different year, at 200 mm rather than 160, DR 60 rather than 80 and ENH 4 rather than 2 \u2014 which is the page\u2019s own thesis working on it: the settings change the picture, so both panels are printed under both frames.\",\"name\":\"Fluid, and the window it opens\",\"width\":1781,\"height\":1293,\"representativeOfPage\":true,\"creditText\":\"Suresult clinical image library\",\"copyrightNotice\":\"Suresult\"},{\"@type\":\"VideoObject\",\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#figure-2\",\"name\":\"The lung base with nothing in it on a Suresult convex probe\",\"description\":\"The lung base with nothing in it. The same window with the air still in it, and it is mostly black on purpose. Air stops the beam at the pleural surface, so the screen shows a narrow wedge of chest wall and then shadow. The diaphragm, the liver and the spleen are behind that air and cannot be seen from here. Compare it with figure 1: fluid is what opens the window, and this is what the window looks like shut.\",\"contentUrl\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/lung-base-aerated-no-fluid-ultrasound-cine.mp4\",\"thumbnailUrl\":[\"https:\/\/suresultmed.com\/wp-content\/uploads\/lung-base-aerated-no-fluid-ultrasound-cine-poster.jpg\"],\"uploadDate\":\"2017-01-07\",\"duration\":\"PT10S\",\"width\":864,\"height\":656,\"isFamilyFriendly\":true,\"inLanguage\":\"en\",\"publisher\":{\"@type\":\"Organization\",\"@id\":\"https:\/\/suresultmed.com\/#suresult-merchant\",\"name\":\"Suresult\",\"url\":\"https:\/\/suresultmed.com\/\"},\"mainEntityOfPage\":{\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#webpage\"}},{\"@type\":\"VideoObject\",\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#figure-3\",\"name\":\"The same chest, swept on a Suresult convex probe\",\"description\":\"The same chest, swept. Gain is eleven decibels higher here than in the frozen frame above, and the fluid stops looking uniformly black: strands and moving echoes appear inside it. Turning gain up is how a collection that reads as simple starts to read as complex, which is why the number on the screen belongs in the record.\",\"contentUrl\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-effusion-ultrasound-cine.mp4\",\"thumbnailUrl\":[\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-effusion-ultrasound-cine-poster.jpg\"],\"uploadDate\":\"2018-03-19\",\"duration\":\"PT5.7S\",\"width\":480,\"height\":352,\"isFamilyFriendly\":true,\"inLanguage\":\"en\",\"publisher\":{\"@type\":\"Organization\",\"@id\":\"https:\/\/suresultmed.com\/#suresult-merchant\",\"name\":\"Suresult\",\"url\":\"https:\/\/suresultmed.com\/\"},\"mainEntityOfPage\":{\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#webpage\"}},{\"@type\":\"ImageObject\",\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#figure-4\",\"contentUrl\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/atelectatic-lung-in-pleural-fluid-ultrasound.jpg\",\"url\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/atelectatic-lung-in-pleural-fluid-ultrasound.jpg\",\"caption\":\"Lung inside the fluid. A wedge of tissue that looks like solid organ rather than air, bounded by dark fluid on one side and the bright curved diaphragm below. Airless lung conducts sound, so it draws with texture instead of stopping the beam. Frozen, it is a shape; it is the movement that names it.\",\"name\":\"Lung inside the fluid\",\"width\":1781,\"height\":1293,\"representativeOfPage\":false,\"creditText\":\"Suresult clinical image library\",\"copyrightNotice\":\"Suresult\"},{\"@type\":\"VideoObject\",\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#figure-5\",\"name\":\"The same lung, moving on a Suresult convex probe\",\"description\":\"The same lung, moving. The collapsed lobe drifts inside the collection as the chest moves. The literature calls this the jellyfish sign, and it is a B mode appearance; the M mode trace taken through the same space is a separate finding with its own name, the sinusoid sign. Watch the frequency on the panel as well: the operator runs 3.5 MHz for the first ten frames and switches to harmonic 5.0 MHz at frame 11.\",\"contentUrl\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/atelectatic-lung-moving-in-pleural-fluid-cine.mp4\",\"thumbnailUrl\":[\"https:\/\/suresultmed.com\/wp-content\/uploads\/atelectatic-lung-moving-in-pleural-fluid-cine-poster.jpg\"],\"uploadDate\":\"2018-03-19\",\"duration\":\"PT3.8S\",\"width\":912,\"height\":672,\"isFamilyFriendly\":true,\"inLanguage\":\"en\",\"publisher\":{\"@type\":\"Organization\",\"@id\":\"https:\/\/suresultmed.com\/#suresult-merchant\",\"name\":\"Suresult\",\"url\":\"https:\/\/suresultmed.com\/\"},\"mainEntityOfPage\":{\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#webpage\"}},{\"@type\":\"ImageObject\",\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#figure-6\",\"contentUrl\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-effusion-atelectasis-second-study-ultrasound.jpg\",\"url\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/pleural-effusion-atelectasis-second-study-ultrasound.jpg\",\"caption\":\"A second patient, the same pattern. The only frame on this page from a different study than the other effusion images. The curled tissue edge against the bright diaphragmatic line repeats what the first study shows, which is the point of including it. It is also the one frame here whose parameter panel was cropped out of the export, so its settings cannot be read off the screen the way the rest can.\",\"name\":\"A second patient, the same pattern\",\"width\":590,\"height\":554,\"representativeOfPage\":false,\"creditText\":\"Suresult clinical image library\",\"copyrightNotice\":\"Suresult\"},{\"@type\":\"VideoObject\",\"@id\":\"https:\/\/suresultmed.com\/pleural-effusion-ultrasound-images\/#figure-7\",\"name\":\"Two compartments in one study on a Suresult convex probe\",\"description\":\"Two compartments in one study. Logged in the reference library as pleural fluid with a pericardial collection in the same examination. Which compartment a dark space belongs to is settled by the descending thoracic aorta: pericardial fluid tracks in front of it, pleural fluid behind and lateral to it. 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