A middle aged woman with no previous cardiac history presented with breathlessness
Multiple lung rockets were seen throughout the chest, most prominent at the bases. The pleural line was thin and smooth with normal lung sliding.
There were small bibasal effusions (not shown).
Lung rockets are reverberation artefacts that arise from the pleural surface and extend to the edge of the screen, obliterating all other lines (don't confuse them with the short comet tail artefacts that only go a short distance and can be normal). They are due to increased interstitial thickening, either from fluid or fibrosis. Pulmonary fibrosis and infection (e.g. pneumonia) are other causes, but tend to also cause small areas of atelectasis resulting in an irregular and often thickened pleural line, and usually reduced or absent lung sliding. As a result, the combination of a smooth pleural line, normal sliding and multiple rockets is highly suggestive of congestive cardiac failure. The degree of CCF can be judged by determining how far up the lung they occur as they tend to be distributed according to gravity (just like crackles on auscultation). Some say 1-2 rockets per field at the bases can be normal (particularly in the more elderly).
If there's a large number of rockets they can 'fuse' to give a white appearance to the whole lung.