5
EASy MAPRight Pleural
View 5 · probe position E · right midaxillary line
Machine setup
- Same sector probe; wipe excess gel off the chest wall and re-gel.
- Adult Cardiac preset, B-mode, marker upper right.
- Depth stays at 21 cm — the same depth for all six views; it carries the spine onto the bottom of the screen.
- Gain set so the hepatic parenchyma is mid-grey and the diaphragm reads bright.
Acquire
- Place the probe at the right midaxillary line, in the same horizontal plane as the subxiphoid cardiac view, marker at 12 o'clock (superiorly).
- Identify the liver, then angle the beam cephalad to bring in the diaphragm — a curved hyperechoic band immediately cephalad to the liver.
- If beam transmission is poor, slide more posteriorly to image through more hepatic parenchyma.
- Angle the tail anteriorly to bring in the anterior surface of the spine at the bottom of the screen — a hyperechoic line with shadow beyond it.
- Identify the lung: it sweeps a large acoustic shadow across the screen with inspiration.
Pitfalls
- Stopping at the diaphragm — without the spine in view you cannot call the spine sign.
- Imaging too anteriorly and losing the hepatic window; go posterior instead of pressing harder.
- Mistaking the mirror-image artifact above the diaphragm for effusion — fluid sits above the diaphragm and abolishes the curtain.
- Dropping the depth below 21 cm and losing the spine off the bottom of the screen.
Confirm before you record
Liver, diaphragm, spine and lung must all be in view simultaneously. Record the clip only once you have all four in one frame — anything less will not answer the effusion question.
Read it
- Pleural effusion or other pleural fluid (hemothorax in trauma) — note any loculations.
- Consolidation directly: hyperechoic patchiness within the parenchyma.
- Consolidation indirectly: the spine sign, or loss of the airspace curtain.
- A large effusion or hemothorax is an obstructive contributor — read it against the IVC.
What this view adds
The obstructive and structural contributors — hemothorax, a large effusion, consolidation. With a plethoric IVC, this is where you look before you call the shock cardiogenic.