Illustration of lung ultrasound procedure.

Lung Ultrasound: A Clearer Picture of Pneumonia

Soraya Malik in Health & Wellness August 2025 • 4 min read.

"How ultrasound is changing the way doctors diagnose and manage complex lung infections."

In modern medicine, diagnostic tools are essential. Among these, ultrasound is an important tool, and its applications are expanding. Ultrasound is useful because it can be used in different locations like an ultrasound lab, at a patient's bedside, in the ER, or even at home using portable devices.

There is growing interest in lung ultrasounds in pulmonology and emergency medicine. However, it is still not used as much as it could be, given its potential.

Ultrasound is known for its ability to easily identify pleural effusions. This finding is often reported as additional information during abdominal or echocardiography scans. In comparison to chest X-rays, ultrasound offers several benefits for detecting pleural effusions.

Why Lung Ultrasound Matters: Seeing Beyond X-Rays

Illustration of lung ultrasound procedure.

We present a case of necrotizing pneumonia affecting the basal segment of the left lower lobe. While the responsible germ wasn't identified, the condition responded to broad-spectrum antibiotics. A standard chest X-ray taken in the emergency room revealed lung consolidation. However, a follow-up ultrasound exposed areas of necrosis that the X-ray missed. These necrotic areas were later confirmed by a CT scan.

Even without identifying the exact cause, these ultrasound findings led us to suspect an anaerobic infection. Anaerobic bacteria are common culprits in necrotizing pneumonia and lung abscesses. As a result, we adjusted the antibiotic therapy to include drugs effective against anaerobic organisms.

Detecting small fluid collections: Ultrasound can detect even small pockets of fluid that might be missed on a chest X-ray, particularly when the patient is lying down.
Distinguishing fluid types: Ultrasound can differentiate between different types of fluid, such as identifying complex fluid or fibrin strands indicative of an exudate.
Guiding procedures: Ultrasound helps ensure safety when performing thoracentesis (fluid drainage).

Beyond pleural effusions, lung ultrasound can also detect pulmonary consolidations. It can differentiate between consolidation and concurrent pleural effusion in cases of pleuropneumonia. On ultrasound, pulmonary consolidation appears as a liver-like area with air bronchograms inside. It can be challenging to differentiate between infectious consolidation and collapse (atelectasis) since both show a liver-like appearance. The presence of parallel, non-branching air bronchograms or fluid bronchograms suggests atelectasis. If a pleural effusion causes the collapse, the size of the effusion will indicate the degree of compression on the lung tissue.

The Future of Lung Ultrasound

This case highlights the value of lung ultrasound in managing pneumonia. It offers a safe, repeatable method for monitoring the infection's progress and complements clinical assessments. Lung ultrasound is an important tool for diagnosing and treating pleuropulmonary diseases, which are commonly encountered in internal medicine. It empowers physicians with diagnostic capabilities.

About this Article -

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Everything You Need To Know

What is lung ultrasound, and why is it becoming more important?

Lung ultrasound is a diagnostic imaging technique that uses sound waves to visualize the lungs. It's gaining importance because it offers several advantages over traditional methods like chest X-rays, particularly in diagnosing and managing pneumonia. Lung ultrasound can be used in various settings, including the bedside, emergency rooms, and even at home, making it a versatile tool in modern medicine. It provides detailed insights into the lungs, helping physicians diagnose and monitor conditions more effectively.

How does lung ultrasound help in diagnosing pneumonia?

Lung ultrasound aids in diagnosing pneumonia by providing detailed images of the lungs that can reveal features often missed by chest X-rays. It can detect pleural effusions, which are fluid collections around the lungs, and pulmonary consolidations, which are areas of the lung that have filled with fluid or other substances. It can also differentiate between different types of fluid, aiding in treatment decisions. For instance, it helps in identifying lung abscesses, and it allows clinicians to monitor the infection's progress and guide treatment decisions.

What are the advantages of lung ultrasound over chest X-rays, specifically regarding pleural effusions?

Lung ultrasound offers several advantages over chest X-rays when it comes to detecting and managing pleural effusions. Ultrasound can detect even small fluid collections that may be missed on an X-ray, especially when a patient is lying down. Moreover, ultrasound can differentiate between different types of fluid, such as identifying complex fluid or fibrin strands indicative of an exudate. It also provides guidance for procedures like thoracentesis (fluid drainage), ensuring safety and accuracy.

In the context provided, what are pulmonary consolidations, and how are they identified using lung ultrasound?

Pulmonary consolidations are areas of the lung that have filled with fluid or other substances, often due to pneumonia or other infections. On lung ultrasound, these consolidations appear as a liver-like area with air bronchograms inside. This appearance can help clinicians identify consolidation, but it is important to differentiate it from lung collapse (atelectasis). The presence of parallel, non-branching air bronchograms or fluid bronchograms suggests atelectasis. When a pleural effusion causes the collapse, the size of the effusion indicates the degree of compression on the lung tissue.

How can lung ultrasound findings influence the treatment of pneumonia, as illustrated in the case of necrotizing pneumonia?

In the case of necrotizing pneumonia, lung ultrasound findings were crucial in guiding treatment. The ultrasound revealed areas of necrosis that the initial chest X-ray missed. This led the medical team to suspect an anaerobic infection, which is common in necrotizing pneumonia and lung abscesses. Based on this, they adjusted the antibiotic therapy to include drugs effective against anaerobic organisms. This illustrates how lung ultrasound not only helps in diagnosis but also directly impacts treatment decisions, leading to more effective patient care.