4
EASy MAPLeft Upper Lung
View 4 · probe position D · 2nd ICS, left midclavicular line
Machine setup
- Same sector probe, carried over from the subcostal views.
- Adult Cardiac preset, B-mode, marker upper right.
- Depth stays at 21 cm — the same depth for all six views.
- If image quality is poor, switch to the Adult Lung preset and re-optimize.
- Gain set so the airspaces of the lung parenchyma appear black.
Acquire
- Move across to the 2nd intercostal space at the left midclavicular line, marker at 12 o'clock.
- Apply gentle pressure and/or slide vertically to minimize rib shadowing.
- Tilt the tail slightly laterally to keep the beam perpendicular to the pleura.
- Set gain so the airspaces are black, then record a clip.
Pitfalls
- Sliding off the midclavicular line and imaging over the heart instead of lung.
- Rib shadowing mistaken for absent sliding.
- Comparing the two sides at different gains — depth is fixed at 21 cm, so match the gain before you call asymmetry.
- Stopping here: the pleural views still change the picture.
Read the pair together
The anterior upper lungs are read as a pair. Bilateral A-lines support a dry, fluid-tolerant picture; bilateral B-lines mark the ceiling on volume. A unilateral profile points at a focal process, not at volume state.
Read it
- A-lines vs B-lines, and whether the profile is symmetric.
- Lung sliding at the pleural line.
- Neither A- nor B-lines — suboptimal probe-to-pleura angle; re-optimize.
If you switch presets
Moving from a cardiac to a lung preset moves the marker indicator to the left of the screen and reverses image orientation. Re-orient before you read the image.
What this view adds
Symmetry. With view 3 it settles fluid tolerance for the whole patient — and a one-sided profile redirects you to a focal process rather than a volume problem.