Air and its Sonographic Appearance: Understanding the Artifacts

Simran Buttar, Denrick Cooper, Patrick Olivieri, Michael Barca, Aaran B. Drake, Melvin Ku, Gabriel Rose, Sebastian D. Siadecki, Turandot Saul

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background Although air has traditionally been considered a barrier to sonographic imaging, when encountered in unusual settings it can serve as an important indicator of various pathologic states as well. Clinician recognition and thorough understanding of the characteristic pattern of artifacts generated by air are critical for making a number of important diagnoses. Case Series We present five emergency department cases in which air was visualized in a pathologic location. Pneumothorax, pneumoperitoneum, necrotizing fasciitis, or Fournier's gangrene, and subcutaneous emphysema and pneumomediastinum, can be rapidly and easily identified on ultrasound by the presence of air artifacts. The relevant sonographic findings are described and discussed in this article. Why Should an Emergency Physician Be Aware of This? Due to its inherent impedance mismatch with other human tissues, air has a characteristic appearance on ultrasound that includes irregular hyperechoic structures, “dirty shadowing,” A-lines, and decreased visualization of deeper structures. Knowledge of the sonographic appearance of air artifacts can assist the physician in making a diagnosis, selecting appropriate additional imaging, and enlisting specialist consultation.

Original languageEnglish
Pages (from-to)241-247
Number of pages7
JournalJournal of Emergency Medicine
Issue number2
StatePublished - Aug 2017
Externally publishedYes


  • air artifact
  • bedside ultrasound
  • point of care ultrasound
  • sonographic artifact
  • ultrasound


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