The value of ultrasound examination of the pleura and lungs remains
highly underestimated to this day. While the ventilated lungs
and the osseous skeleton of the thorax represent potent obstacles
for ultrasound, a multitude of pathological processes of the chest
wall, pleura, and lungs results in altered tissue composition,
providing markedly increased access and visibility for sonographic
examination. These conditions support the sonographic diagnosis
of pleural and pulmonary disorders. However, the main value of
pleura and lung ultrasonography is not the primary diagnosis of
chest lesions but the follow up, differential diagnosis, detection
of complications, such as abscesses and post embolic lung infarction,
and guidance of diagnostic and therapeutic interventions in patients
with pathological pleural and pulmonary findings (2). Major advantages
include bedside availability, absence of radiation, and guided
aspiration of fluid-filled areas and solid tumors. Pulmonary vessels
and vascular supply of consolidations may be visualized without
with clinically and radiologically confirmed pneumonia : 88% could
be visualised in the sonogram of patients. 6% had a pleural effusion.
The remaining 6% had no pathological findings (7).
The consolidated area of the lung is usually hypoechoic, poorly
defined, and wedge-shaped. The air-filled bronchi produce linear,
high-amplitude branching echoes that converge toward the lung
root. Posterior acoustic shadowing and reverberation artifacts
are seen accompanying the proximal large bronchi (10).
Ultrasonographic examination can reveal an accumulation of anechogenic
to hypoechogenic fluid in the pleural space associated with echogenic
bands of fibrin between the thoracic wall and pulmonary surface.
ultrasonically guided lung aspiration is a technique with a high
diagnostic yield and a low complication rate for various types
of pneumonia. It is especially useful for patients without satisfactory
clinical responses or without accurate microbiologic diagnosis
Targhetta and Bourgeois (8) reported a series of thirty-nine consecutive
patients with consolidated lung confirmed radiologically underwent
sonography, and their sonograms were compared with results for
healthy subjects, The hyperechoic line of normal aerated lung
and its air artifacts showed respiratory motions (''gliding sign'').
Patients with pneumonia demonstrated distinct sonographic patterns.
Strong linear echoes with characteristic air artifacts (air bronchogram)
and anechoic tubular structures (fluid bronchogram) were visualized
in 92 % of patients. The superficial lung showed a homogeneous
hypoechoic band termed 'superficial fluid alveolograms'' with
respiratory motions in 90-100 %. they conclude that sonography
can evaluate pulmonary consolidation and may provide additional
roentgenographic information, especially when fluid bronchograms
1° Focal alveolar syndrome :
2° Diffused alveolar syndrome :
Pulmonary edemas, vascular inflammation.
Disease of the hyalin membranes.
Sarcoidosis (alveolar form).
Alveolar Protéinose, alveolar Microlithiasis.
Chest x-ray :
Chest radiograph findings indicate a segmental or lobar opacity
with air bronchogram with or without pleural effusion.
ultrasonography is useful for the evaluation of pulmonary consolidation.
(9). Major advantages include bedside availability, absence of
radiation, and guided aspiration of fluid-filled areas and solid
tumors. Pulmonary vessels and vascular supply of consolidations
may be visualized without contrast. US may help to diagnose conditions
such as associate pleural or pericardial effusion.
* 1: Mathis G. [Thoraxsonography--part 2--Subpleural
lung lesions] Schweiz Rundsch Med Prax. 2004 Apr 21;93(17):719-24.
2: Dietrich CF, Hirche TO, Schreiber D, Wagner TO. [Sonographie
von pleura und lunge] Ultraschall Med. 2003 Oct;24(5):303-11.
* 3: Beckh S, Bolcskei PL, Lessnau KD. Real-time chest ultrasonography:
a comprehensive review for the pulmonologist. Chest. 2002 Nov;122(5):1759-73.
* 4: Krejci CS, Trent EJ, Dubinsky T. Thoracic sonography. Respir
Care. 2001 Sep;46(9):932-9. Review. * 28: Mathis G, Gehmacher
O. [Lung and pleural ultrasound] Schweiz Rundsch Med Prax. 2001
Apr 19;90(16):681-6. German.
* 5: Braun U, Pusterla N, Fluckiger M. Ultrasonographic findings
in cattle with pleuropneumonia. Vet Rec. 1997 Jul 5;141(1):12-7.
* 6: Chen CH, Lai CL, Chiu MH, Liu RD, Shih JF, Lee YC, Perng
RP. [Diagnostic value of ultrasonically guided lung aspiration
in pneumonia] J Formos Med Assoc. 1995 Dec;94 Suppl 2:S137-43.
* 7: Gehmacher O, Mathis G, Kopf A, Scheier M. Ultrasound imaging
of pneumonia. Ultrasound Med Biol. 1995;21(9):1119-22.
* 8: Targhetta R, Chavagneux R, Bourgeois JM, Dauzat M, Balmes
P, Pourcelot L. Sonographic approach to diagnosing pulmonary consolidation.
J Ultrasound Med. 1992 Dec;11(12):667-72.
* 9: Yang PC, Luh KT, Chang DB, Yu CJ, Kuo SH, Wu HD. Ultrasonographic
evaluation of pulmonary consolidation. Am Rev Respir Dis. 1992
* 10: Weinberg B, Diakoumakis EE, Kass EG, Seife B, Zvi ZB. The
air bronchogram: sonographic demonstration. AJR Am J Roentgenol.