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Background <p>Pneumothorax is a potentially life-threatening complication in critically ill patients. Lung ultrasound (LUS) is highly accurate for bedside diagnosis, with the lung point sign being specific for pneumothorax. A variant, the heart point sign, has been described in isolated case reports as a marker of left-sided pneumothorax, but its clinical relevance remains incompletely understood.</p> Methods <p>We retrospectively reviewed intensive care unit cases at Sanatorio Los Arcos (Buenos Aires, Argentina) from January 2018 to July 2024. Patients were included if the heart point sign was documented during cardiac ultrasound performed as part of the hemodynamic assessment following the diagnosis of pneumothorax by lung ultrasound. The sign was evaluated in B-mode and, when available, M-mode, and defined as the visualization of the heart during diastole that disappeared during systole, coinciding with a lung pattern showing absent lung sliding and A-lines. Clinical data, confirmatory imaging, and management strategies were obtained from medical records.</p> Results <p>Ten patients (median age 56 years, IQR 45–65; 50% male) exhibited the heart point sign. Most patients (80%) were on invasive mechanical ventilation, and two required vasopressor support. The sign was visualized in parasternal (6/10) and apical (4/10) views. Pneumothorax was confirmed by CT (5/10), chest radiography (3/10), or ultrasound alone (2/10). Etiologies included central line placement (5/10), surgical complications (2/10), failure of lung re-expansion (1/10), spontaneous pneumothorax (1/10), and lung abscess rupture (1/10). Management consisted of chest tube insertion (6/10), video-assisted thoracoscopic surgery (3/10), and conservative observation (1/10).</p> Conclusion <p>The heart point sign is an infrequent but highly specific sonographic marker of left-sided pneumothorax. It can be assessed in B-mode and M-mode, reflecting the dynamic interaction between cardiac motion and interposed pleural air. Recognition of this sign provides rapid bedside confirmation, complementing classical ultrasonographic findings and enhancing diagnostic confidence in critically ill patients.</p>

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The heart point sign: a bedside ultrasound marker of left-sided pneumothorax in critically ill patients−a case series

  • 期刊论文

  • 发表日期：

    2025年11月23日

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  • Issac Cheong,
  • Federico Matías Álvarez Vilariño,
  • Pablo Martín Merlo,
  • Francisco Marcelo Tamagnone

摘要

Background

Pneumothorax is a potentially life-threatening complication in critically ill patients. Lung ultrasound (LUS) is highly accurate for bedside diagnosis, with the lung point sign being specific for pneumothorax. A variant, the heart point sign, has been described in isolated case reports as a marker of left-sided pneumothorax, but its clinical relevance remains incompletely understood.

Methods

We retrospectively reviewed intensive care unit cases at Sanatorio Los Arcos (Buenos Aires, Argentina) from January 2018 to July 2024. Patients were included if the heart point sign was documented during cardiac ultrasound performed as part of the hemodynamic assessment following the diagnosis of pneumothorax by lung ultrasound. The sign was evaluated in B-mode and, when available, M-mode, and defined as the visualization of the heart during diastole that disappeared during systole, coinciding with a lung pattern showing absent lung sliding and A-lines. Clinical data, confirmatory imaging, and management strategies were obtained from medical records.

Results

Ten patients (median age 56 years, IQR 45–65; 50% male) exhibited the heart point sign. Most patients (80%) were on invasive mechanical ventilation, and two required vasopressor support. The sign was visualized in parasternal (6/10) and apical (4/10) views. Pneumothorax was confirmed by CT (5/10), chest radiography (3/10), or ultrasound alone (2/10). Etiologies included central line placement (5/10), surgical complications (2/10), failure of lung re-expansion (1/10), spontaneous pneumothorax (1/10), and lung abscess rupture (1/10). Management consisted of chest tube insertion (6/10), video-assisted thoracoscopic surgery (3/10), and conservative observation (1/10).

Conclusion

The heart point sign is an infrequent but highly specific sonographic marker of left-sided pneumothorax. It can be assessed in B-mode and M-mode, reflecting the dynamic interaction between cardiac motion and interposed pleural air. Recognition of this sign provides rapid bedside confirmation, complementing classical ultrasonographic findings and enhancing diagnostic confidence in critically ill patients.