Lung Ultrasound and Septated Posterior Pneumothorax in Patients with the B’-Profile of the BLUE-Protocol

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TheB’-profile of the BLUE-protocol describes abolished lung sliding with lung rockets at the anterior chest wall. It indicates pneumonia or ARDS. We explain abolished lung sliding by pleural symphysis. In such patients, if a pneumothorax occurs, it can be septated. We experienced a case of pneumonia with a B’-profile and a sudden worsening of respiratory function due to a posterior pneumothorax. The ultrasound signs were limited to a “posterior A’-profile” (the term A’-profile implies that abolished lung sliding with complete absence of B-line is detected at the anterior wall). There was no lungpoint, a frequent finding in these septated pneumothoraces occurring on pathological lungs. In conclusion, in patients with a B’-profile, a pneumothorax can occur elsewhere than the anterior, classical location. Conversely, we assume that an anterior lung sliding indicates a free movement of the lung against the parietal pleura, and should logically rule out posterior, septated pneumothorax.