UMEM Educational Pearls

Category: Ultrasound

Title: What’s the talk about the Lipliner Sign?

Keywords: POCUS; FAST exam (PubMed Search)

Posted: 9/30/2024 by Alexis Salerno, MD (Updated: 10/10/2024)
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The Lipliner Sign is causing a lot of buzz within the ultrasound community, particularly concerning its implications for focused assessment with sonography for trauma (FAST) exams. This artifact arises from postprocessing techniques that enhance organ visualization but can inadvertently create a hypoechoic line that resembles free fluid leading to false positive exams. 

Key points to note: 

Nature of the Artifact: The Lipliner Sign manifests as a linear, hypoechoic outline around an organ, misleading clinicians into thinking there's free fluid present. 

Differentiation: As mentioned in this case report, free fluid typically appears wedge-shaped and tapers as it moves into dependent areas, while the Lipliner Sign is more linear and closely follows the organ's contour. 

Manufacturer Variability: This artifact can be observed across different ultrasound machine manufacturers. 

Clinical Implications: Misinterpretation of the Lipliner Sign could lead to unnecessary interventions or misdiagnoses in trauma settings, underscoring the importance of thorough training and awareness of potential artifacts.

References

Parker M, Hicks BG, Kaili M. The Lipliner Sign: Potential Cause of a False Positive FAST Examination. JEM in Press 2024. DOI: 10.1016/j.jemermed.2024.06.013