Table 1 The diagnostic findings applied to assess traumatic chest injuries in physical exam and ultrasonography
Assessment | Definition | Simple pneumothorax | Tension pneumothorax | Hemothorax | Massive hemothorax | Pulmonary contusion |
|---|---|---|---|---|---|---|
Findings of physical examination | ||||||
 Inspection | Chest expansion | Nl-↓ | ↓ | ↓ | ↓ | Nl |
Trachea | Nl | Deviated | Nl | Deviated | Nl | |
Jugular vein pressure | Nl | ↑ | Nl | ↓ | Nl | |
 Percussion | The sound of striking 2 fingers on intercostal spaces | Nl-hyperresonance | Hyperresonance | Nl-dull | Dull | Nl |
 Auscultation | To hear both sides comparatively and note sounds’ quality | ↓ | Nl-dull | Nl-↓ | ↓ | Nl-crackles |
Findings of ultrasonography | ||||||
 Pleural sliding | The shimmering movement of parietal pleura during inspiration | Lost in injured zone | Lost | Nl | May be Nl | Maybe falsely ↓ |
 Seashore sign | Normal lung M-mode of sandy appearance above and parallel lines below | Lost in injured zone | Lost | Nl | May be Nl | May be Nl |
 Barcode/stratosphere sign | Abnormal M-mode showing multiple parallel lines | + in injured zone | + | – | – | May be falsely + |
 Lung point | The interface of normal lung and pneumothorax area in B-M mode | May be + | Often - | – | – | – |
 Sinusoid sign | The sinusoidal movement of the collapsed lung in the pleural fluid | – | – | + | + | – |
 V-line | Echogenic vertebral line with posterior shadow due to the transmission of ultrasound waves through the pleural fluid | – | – | May be + | + | – |
 B-lines/comet tails | Vertical echogenic artifact lines from the pleura to the screen edge, if multiple, resulting from alveolo-interstitial syndrome (rocket sign) | Lost | Lost | Nl | May be Nl | ↑ |
 Peripheral parenchymal lesions | Lung hepatization with subpleural hypoechoic foci and pleural line gap | – | – | – | – | + |