This elderly COPD patient fell over and sustained a rib fracture.
He had considerable pain and increasing shortness of breath.
On examination he had some chest wall swelling and fine crepitus consistent with surgical / subcutaneous emphysema.
We wondered whether we could determine the presence of a pneumothorax, and if so its size.
There is a narrow area of normal subcutaneous tissue seen, and then homogenous echogenic artefact fills the entire image.
It looks a little like "clouds with rain" and is infact extensive surgical emphysema.
The severity and extent of surgical emphysema can vary significantly.
Here there is marked subcutaneous air completely obscuring the image. Gentle firm transducer pressure can push the air away enabling a better view.
With less remarkable surgical emphysema small pockets of superficial air obscure small parts of the image and are clearly evident because they are bright with posterior reverberation artefact.