Tsunami Lung

As you know, I have been presenting a technique of ultrasound-guided thoracic paravertebral block with a transverse scan in an in-plane approach. In my technique, you can place a catheter into the thoracic paravertebral space more easily than the technique with a longitudinal view of the thoracic paravertebral space.

This week, I met a patient with a rare ultrasound image of the thoracic paravertebral space. The patient was swept up by the huge tsunami after the Tohoku earthquake and then was suffering from a thoracic empyema.  I performed ultrasound-guided TPVB for the patient undergoing an open chest drainage. The ultrasonographic image was notable for us. The pus between the parietal and the visceral pleura was visualized as a hypoechoic wedge-shaped space seen. Therefore, it was seen as a thoracic paravertebral space. On the other hand, the thoracic paravertebral space appeared more hyperechoically than usual, and  was seen a part of the external intercostal muscle. You will not be able to identify the internal intercostal membrane if you have not watched the ultrasonographic image.
I called the ultrasonographic image "Tsunami Lung".