Comet-Tail (Resonance Artifact):

in Aerated Structures
At the margin, of the lung surface and air one frequently finds small comet-tail artifacts (Figs. 8.2-8.4, 8.9).
They are seen as bright, narrow strips of strong dorsal reflectors and their origin is controversially
discussed. One explanation is reverberations (repetitive echoes) between two very closely located
reflectors and resonance phenomena (vibrations) with a strong echo response. In addition to air or other
gas bubbles, a common site of origin is metal foreign bodies

(Mathis Gebhard, Chest Sonography, Springer Heidelberg, Germany, 2008)

Probably the most important observationor identifying a pneumothorax is the absence of the “gliding” or
“sliding” lung. This refers to the bright hyperechoic line of the visceral pleura, which is attached to the
lung and moves with it during respiration. Observing the absence o lung sliding is greater than 90%
accurate in diagnosing a pneumothorax. Also absent in pneumothorax is the normal reverberation artifact
of aerated lung. Instead, there is only the bright, specular reflection o air in the pleural cavity, which does
not move and produces what has been called a comet tail, ringdown, or free-air artifact. This artifact can
be distinguished from the reverberation artifact found in the normal lung by its greater brightness. In
addition, the distance between the repeating bands of comet tail artifact is less than the distance between
the skin-to-lung interface, whereas the distance between these repeating bands matches the distance of
the skin-to-lung interface in the reverberation artifact of normally aerated lung. (Sanders, Roger. Clinical
Sonography, Wolters Kluwer.Philadelphia. 2016)

B lines: Changes in normal air/fluid balance in lung zones (loss of air) generates vertical laser-like artifacts
(B-lines). B-lines blur, or even completely erase, the “mirror effect . ” Depiction of multiple and diffuse B-
lines indicates loss of the lung’s aeration and increase of interstitial fluids. However, presence of air in the
pleural space prevents B-line visualization. Thus even one isolated B-line rules out the diagnosis of
pneumothorax. Absence of B-lines is not only observed in pneumothorax. In case of absence of lung sliding
and B lines, other signs also should be evaluated to definitively rule in pneumothorax (Lumb,Philips.
Critical Care Ultrasound. Elvesier. California. 2015)
The vertical “comet-tail” artifact, or “B line,” has several characteristics. It arises from the pleural line, is
well defined, spreads to the edge of the screen without fading, erases A lines, and moves with lung sliding.
Several simultaneously visible B lines are labeled “lung rockets” and may indicate interstitial syndrome
generated by pathologic conditions. The B lines can be isolated and do not possess precise pathologic
significance. As B lines are generated by the visceral and not parietal pleura, it is expected these would no
longer be visible in the case of pneumothorax; however, this is not always the case. Another kind of comet-
tail artifact arises from the pleural line and is vertical like the B line but is otherwise different: It is ill
defined, vanishes after a few centimeters, does not reach the screen limits, does not erase the A lines,
and is independent of lung sliding. This is referred to as the “Z line” and may or may not be associated
with pneumothorax. The area where normal lung findings disappear is known as the “lung point,” a
dynamic sign that corresponds to the edge of the pneumothorax (43). It is visible with respiratory
excursion as the transducer is held in a fixed position on the patient’s chest, but is only
momentarily visualized. (McGahan, John. Diagnostic Ultrasound. InformaHealthcare. New York.2017)

Occasional comettail artifacts (B lines) in dependent areas, caused by fluidfilled interlobular septae. On
imaging, these are seen as near vertical lines radiating out from the pleural stripe and extending to the
bottom of the image.
B lines are a type of comet-tail artifact that are long, well-defined, hyperechoic lines that fan out to the
edge of the screen, erase A lines, and move with respiration (Figures 4.27a and b—clip). Visualization of
B lines in a healthy adult is usually confined to the last intercostal space above the diaphragm and may
also be seen if scanning over the area of an interlobar fissure. Certain diseases causing thickening of the
interlobular septa (e.g., interstitial edema, lymphangitis, interstitial lung disease) increase the number of
B lines seen (often termed “lung rockets” when multiple), and the presence of ≥3 artifacts <7 mm apart is
generally felt to be a realistic watershed between normal and pathological

(Tobin, Claire. Pleural Ultrasound for Clinicians. CRC Press. Boca Raton. 2014)