• Alessandro Zanforlin, Vanina Livi, Carlo Santoriello, Paolo Ceruti, Marco Trigiani, Manlio Valerio, Cristiano Perani, Paolo Carlucci, Antonio Palmiotti, and Giampietro Marchetti.
• SOC Medicina, Ospedale San Luca, Trecenta, Italy. Electronic address: alessandro.zanforlin@gmail.com.
• Chest. 2018 Aug 1; 154 (2): 357-362.

BackgroundLung ultrasound examination is becoming an even more important part of pulmonologists' clinical routine. As indicated in the literature, the coordinates of any findings on lung parenchyma are based on surface landmarks or conventional quadrants. In our experience we have noticed that lung fissures are clearly detectable as interruptions of the pleural line, but this has never been investigated previously. The aim of this study was to evaluate whether lung fissures are detectable under normal conditions in routine clinical practice.MethodsTen operators were enrolled from Pleural-Hub, a scientific discussion group. After compiling a prestudy survey to investigate whether they had observed fissures previously, they were asked to note if the following fissures were detectable: posterior right (PR) and left (PL), lateral right (LR) and left (LL), anterior right (AR), and anterolateral left (AL). Enrollment was competitive, aiming to reach 100 case subjects.ResultsWe found that general fissure detection was 61.3%, in particular: PR, 59%; LR, 75%; AR, 69%; PL, 45%; LL, 64%; AL, 56%. Single operators yielded different detection rates ranging from 90% to 25%, showing strong operator dependency. Before being made aware of general results operators indicated operator's skill and rib shadow artifacts as the principal factors affecting fissure detection.ConclusionsLung fissures may be detected with ultrasound once adequate training is provided. This may allow the clinician a more precise anatomical delineation of pathology identified by lung ultrasound.Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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