The ABZ Lines

ABZs

Nomenclature for detecting interstitial lung fluid

Narration

In addition to interrogating the pleural line for sliding to tell us if there’s a pneumothorax or not, we can also look for pathology at the pleural line that may represent something like interstitial fluid from pulmonary edema or CHF. When we do this we use a nomenclature that was developed by Dr. Daniel Lichenstein who was really the father of lung ultrasound, and we’ll talk about A, B, and Z lines with A lines and Z lines being normal, and B lines (the bad ones) being abnormal.

Lines

A line – normal
Reverberation artifact

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Narration

So when we look at the pleural line, a normal reverberation artifact is what we call an A line and these are horizontal lines that are sort of evenly spaced below the pleural line and typically the presence of an A line indicates that you don’t have a pathologic B lines.

Lines

Z line – normal
”Comet tail”
Tapers quickly

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Narration

The other normal lines that we’ll see are what we call Z lines and these are comet tails or little tapering vertical lines that come from the pleural line but don’t go all the way to the back of the field and these are again normal and they help us to define the visceral pleura at the pleural line.

Lines

B line – bad
Abnormal
All the way from pleural line to far field of screen
Does not taper like Z lines

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Narration

Now B lines are the pathologic ones and these are also comet tail artifacts - they are reverberation artifacts that cause a line to go vertically all the way from the pleural line to the far field of the image and they don’t taper like the Z lines so the presence of these, typically if there are more than 3 in a field, indicates pathology.

Thoracic Ultrasound

--- Table of Contents ---

Lesson Name	Minutes	id
Approach to Thoracic Ultrasound	2	81
The Inferior Thoracic Space	2	82
Pleural Effusions	2	83
More Pleural Effusions	3	84
The Anterior Pleural Line	2	85
Ultrasound for Pneumothorax	4	86
M-Mode for Pneumothorax	2	87
Lung Point Sign	2	88
The ABZ Lines	3	89
B lines and AIS	3	90
Pneumonia	2	91
Rib Fracture	1	92