Medical Blog | From Costal Cartilage to Pleura: How Handheld Ultrasound Helps in Chest Scanning

In emergency and critical care, quick and accurate diagnosis is crucial for saving lives. POCUS (Point-of-Care Ultrasound) has become an essential tool for medical professionals due to its portability and efficiency.

This article will walk you through scanning from costal cartilage and explore how handheld ultrasound can be used to diagnose common chest emergencies, such as pleural effusion, pulmonary edema, and pneumothorax. We’ll also share practical scanning techniques and clinical applications.

Costal Cartilage Scanning Tips in the ER

Costal cartilage connects the ribs to the sternum and plays a key role in chest wall movement. Since patients often visit the ER with chest pain or breathing difficulties, scanning this area helps assess respiratory function.

Key Landmark & Reducing Interference: Costal cartilage serves as an important anatomical marker in ultrasound imaging. Traditional ultrasound scans can be affected by rib density, creating shadowing that hides deeper structures. Scanning the costal cartilage helps avoid these interferences, making it easier to find the intercostal spaces and ensure accurate probe placement.
Locating Pathologies: By scanning the costal cartilage, doctors can clearly differentiate between chest wall, pleura, and lung abnormalities. This helps in diagnosing conditions like pleural effusion, pneumonia, or other thoracic diseases, leading to more effective treatment planning.
Faster Diagnosis & Triage: In emergency settings, every second counts. Handheld ultrasound allows for quick scanning of the costal cartilage, minimizing setup time and enabling rapid chest imaging. This improves diagnosis speed and enhances patient care efficiency.

How Ultrasound Helps Assess Pleural & Pulmonary Conditions

Handheld ultrasound plays a crucial role in diagnosing chest conditions. When a patient presents with chest pain, difficulty breathing, or signs of infection, ultrasound helps quickly determine the cause by directly visualizing pleural and lung changes.
(Further reading : Medical Blog | Pulmonary Complications of Influenza A: How Handheld Ultrasound Can Help with Diagnosis and Monitoring)

Pleural Effusion

Pleural effusion refers to abnormal fluid buildup in the pleural cavity, which can be linked to pneumonia, cancer, heart failure, or kidney disease.

Using handheld ultrasound, scanning downward toward the diaphragm helps distinguish between free-flowing and loculated effusions.
In ICU or ER settings, ultrasound provides real-time assessment and guides treatment decisions.

Pulmonary Edema

Pulmonary edema occurs when fluid accumulates in the lungs, impairing gas exchange. This condition is common in heart failure, kidney disease, or acute respiratory distress syndrome (ARDS, Acute Respiratory Distress Syndrome).

Scanning from the costal cartilage area allows for a quick lung assessment.
It helps distinguish between cardiogenic pulmonary edema and pneumonia, guiding decisions on oxygen therapy or diuretics.

Pneumothorax

Pneumothorax happens when air enters the pleural cavity, causing lung collapse. It is often seen in trauma or spontaneous cases.

Small pneumothoraces may be missed on X-ray, but ultrasound provides a more sensitive diagnosis.
Scanning from the costal cartilage, doctors check for the sliding sign—if absent, and a lung point is detected, pneumothorax is confirmed.

Why POCUS is a Game Changer in Chest Diagnosis

POCUS allows for quick lung and pleural assessments, offering advantages over traditional imaging methods like X-ray or CT
(Further reading : ICEM 2024 Showcases Advantages of Apache Handheld Wireless Ultrasound for POCUS Applications)

✅ No radiation exposure—safe for repeated use
✅ Instant imaging feedback—supports real-time decision-making
✅ Usable in various settings—ER, ICU, hospital wards, or even home care

Steps for scanning costal cartilage

Set the scan depth to 3-5 cm and place the probe longitudinally near the sternum.
Identify the dark, cartilage structures on the screen, then slowly move laterally.
Continue scanning until you see a bright, bony structure, indicating the rib.
Here you can see the junction between the bone and cartilage. Rotate the probe transversely
Check for any abnormalities above and below the cartilage, and use ultrasound imaging to effectively distinguish costal cartilage from other structures.
(Further readin ：Aco Smartcare – Costal Cartilage)

This technique helps differentiate costal cartilage from other structures and improves scanning accuracy.

The Importance of Costal Cartilage Scanning in POCUS

Since ribs create acoustic shadowing, limiting the view of deeper structures, scanning costal cartilage helps doctors obtain clearer images. By mastering this technique, physicians can:

Improve diagnostic accuracy
Enhance patient evaluation
Make faster treatment decisions

With handheld ultrasound, medical professionals can perform real-time assessments in ERs, ICUs, outpatient clinics, and more—offering faster, more precise care for patients.
(Further reading : Apache neo L154 Handheld Ultrasound)