ABDOMINAL SONOGRAPHY
Thorax
Plural effusion
{Morphological - Simple Anechoic Pleural Effusion -
Possible Etiological
(Transudative / Uncomplicated Exudative Pleural Effusion)}
Impression: Left-sided pleural effusion, possibly parapneumonic in etiology in the setting of associated pulmonary consolidation. Clinical and radiological correlation is advised.
Recommendation: Clinical correlation with presenting symptoms and laboratory investigations, including complete blood count (CBC), C-reactive protein (CRP), and other inflammatory markers, is recommended. Chest X-ray or CT thorax may be considered for further evaluation of underlying pulmonary pathology. Diagnostic ultrasound-guided thoracentesis with pleural fluid biochemical, cytological, and microbiological analysis may be considered when clinically indicated, particularly in cases of unexplained, moderate-to-large, or suspected complicated parapneumonic effusion. Follow-up chest ultrasonography is advised to assess resolution or progression following appropriate treatment.
{Morphological - Complex Non-Septated Pleural Effusion - Possible Etiological (Exudative / Parapneumonic / Hemorrhagic / Malignant Pleural Effusion)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a complex pleural fluid collection containing scattered low-level internal echoes and echogenic particulate material without definite internal septations. The fluid is predominantly located within the dependent pleural cavity. The appearance is suggestive of a complex non-septated pleural effusion. Associated passive compressive atelectatic changes may be present in the adjacent lung parenchyma. The adjacent pleural surfaces should be assessed for thickening, nodularity, and other associated abnormalities.
Impression: Complex non-septated [right/left]-sided pleural effusion. The sonographic appearance raises the possibility of an exudative effusion, including parapneumonic, hemorrhagic, or malignant etiologies. The underlying cause cannot be determined reliably from sonographic morphology alone.
Recommendation: Clinical correlation with presenting symptoms, medical history, and relevant laboratory investigations is recommended. Complete blood count (CBC), C-reactive protein (CRP), and other inflammatory markers may be useful when infection is suspected. Chest radiography or contrast-enhanced CT thorax may be considered when further evaluation of underlying pulmonary or pleural pathology is clinically indicated. Diagnostic ultrasound-guided thoracentesis with pleural fluid biochemical, microbiological, and cytological analysis should be considered when appropriate to establish the underlying etiology. Follow-up ultrasonography may be performed to assess interval changes.
{Morphological - Complex Septated Pleural Effusion - Possible Etiological (Complicated Parapneumonic / Tuberculous / Empyema-Associated Pleural Effusion)}
Finding: Ultrasound examination of the [right/left] hemithorax demonstrates a complex pleural fluid collection containing multiple thin to thick echogenic internal septations and fibrinous strands, dividing the fluid into communicating or partially compartmentalized spaces. Variable internal low-level echoes and echogenic debris are noted. The findings are consistent with a complex septated pleural effusion. Associated pleural thickening and adjacent compressive atelectatic changes may be present.
Impression: Complex septated [right/left]-sided pleural effusion. The sonographic appearance is suspicious for an organized inflammatory or infective pleural collection, particularly a complicated parapneumonic effusion or empyema in the appropriate clinical setting. Tuberculous pleuritis and other chronic inflammatory etiologies remain possible. Sonographic findings alone cannot confirm the underlying cause.
Recommendation: Prompt clinical assessment and correlation with CBC, CRP, and other relevant inflammatory markers are recommended. Diagnostic ultrasound-guided pleural fluid aspiration should be considered when clinically appropriate, with biochemical analysis including pH, glucose, protein, and LDH, along with Gram stain, bacterial culture, and additional microbiological testing as indicated. Tuberculosis-directed investigations may be considered when clinically suspected. Contrast-enhanced CT thorax may be useful for evaluating pleural organization and associated pulmonary abnormalities. Respiratory or pleural specialist consultation is recommended when complicated parapneumonic effusion or empyema is suspected, as drainage may be required.
{Morphological - Homogeneously Echogenic Pleural Effusion - Possible Etiological (Purulent / Hemorrhagic / Proteinaceous Pleural Effusion)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a pleural fluid collection demonstrating relatively homogeneous diffuse internal echogenicity rather than the typical anechoic appearance of simple fluid. Fine suspended internal echoes are present throughout the collection. The appearance suggests echogenic pleural fluid containing cellular material, blood products, inflammatory debris, or proteinaceous components. Associated pleural thickening, internal septations, and adjacent pulmonary abnormalities should be evaluated.
Impression: Homogeneously echogenic [right/left]-sided pleural effusion. The appearance suggests complex pleural fluid and may be encountered in purulent, hemorrhagic, or protein-rich effusions. The exact composition and etiology cannot be established by ultrasonography alone.
Recommendation: Clinical correlation is recommended to evaluate for infection, trauma, recent procedures, anticoagulant use, or other relevant conditions. CBC, inflammatory markers, and coagulation studies may be appropriate depending on the clinical presentation. Diagnostic ultrasound-guided thoracentesis with biochemical, microbiological, and cytological examination should be considered when indicated. If hemothorax is suspected, pleural fluid hematocrit and urgent clinical assessment may be required. If empyema is suspected, prompt specialist evaluation is advised to determine the need for drainage and antimicrobial treatment. CT thorax may be considered for additional evaluation.
{Morphological - Loculated Pleural Effusion - Possible Etiological (Complicated Parapneumonic / Empyema / Tuberculous / Chronic Inflammatory Pleural Effusion)}
Finding: Ultrasound examination of the [right/left] hemithorax demonstrates a localized pleural fluid collection confined to a restricted portion of the pleural cavity, without the typical freely dependent distribution of simple pleural fluid. The collection demonstrates a loculated configuration, with its margins partially defined by adjacent pleural surfaces or adhesions. Internal echoes, septations, and associated pleural thickening may be present depending on the underlying process.
Impression: Loculated [right/left]-sided pleural effusion. The morphology suggests pleural compartmentalization, which may occur in complicated parapneumonic effusion, empyema, tuberculous pleuritis, or chronic inflammatory pleural disease. Clinical correlation is necessary to determine the underlying etiology.
Recommendation: Clinical correlation with symptoms, inflammatory markers, and relevant medical history is recommended. Contrast-enhanced CT thorax may be considered to define the extent, distribution, and associated pleural or pulmonary abnormalities. Diagnostic ultrasound-guided aspiration may be considered when clinically indicated, taking into account the accessibility and size of the loculated collection. Pleural fluid biochemical, microbiological, and cytological analysis should be performed as appropriate. Respiratory or pleural specialist assessment is recommended when infection or a complicated pleural collection is suspected, particularly if drainage is being considered.
{Morphological - Pleural Effusion with Pleural Thickening - Possible Etiological (Tuberculous / Malignant / Chronic Inflammatory Pleural Effusion)}
Finding: Ultrasound examination of the [right/left] hemithorax demonstrates a pleural fluid collection associated with thickening of the adjacent pleural surfaces. The pleural thickening may be smooth or irregular and may involve the parietal and/or visceral pleura. The pleural fluid may appear anechoic or contain variable internal echoes. Associated pleural nodularity, septations, and adjacent pulmonary abnormalities should be assessed. Pleural thickness and the distribution of the abnormality should be documented where technically feasible.
Impression: [right/left]-Sided pleural effusion with associated pleural thickening. The findings are nonspecific and may occur with chronic inflammatory pleuritis, tuberculous pleural disease, or pleural malignancy. The morphology and distribution of pleural thickening, together with clinical findings, are important for further characterization.
Recommendation: Clinical correlation with the patient's history, constitutional symptoms, and relevant laboratory findings is recommended. Contrast-enhanced CT thorax may be considered for further assessment of pleural thickening and associated thoracic abnormalities. Diagnostic thoracentesis with pleural fluid biochemical, microbiological, and cytological analysis may be appropriate for an unexplained effusion. Tuberculosis-directed investigations should be considered when clinically suspected. Persistent unexplained pleural thickening or suspected malignancy may require specialist assessment and image-guided pleural biopsy or thoracoscopy, depending on the clinical circumstances.
{Morphological - Pleural Effusion with Pleural Nodularity - Possible Etiological (Malignant / Metastatic / Mesothelioma-Associated Pleural Effusion)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a pleural fluid collection associated with focal or multifocal nodular thickening of the adjacent pleural surfaces. The nodules appear as discrete solid pleural-based projections extending toward the pleural fluid. The distribution, size, and echogenicity of the pleural nodules should be documented. Color Doppler examination may demonstrate internal vascularity within solid pleural nodules. Associated irregular pleural thickening and adjacent pulmonary abnormalities should also be evaluated.
Impression: [right/left]-Sided pleural effusion with associated pleural nodularity. The findings are suspicious for pleural neoplastic involvement, including metastatic pleural disease or mesothelioma, particularly when nodularity is irregular or multifocal. Inflammatory and granulomatous pleural conditions may produce overlapping appearances. Histopathological confirmation may be required.
Recommendation: Prompt clinical correlation and respiratory or thoracic specialist evaluation are recommended. Contrast-enhanced CT thorax is advised for further characterization of pleural nodularity, disease extent, and associated thoracic abnormalities. Diagnostic thoracentesis with pleural fluid cytological analysis may be performed when clinically appropriate. Because negative pleural fluid cytology does not exclude malignancy, image-guided pleural biopsy or thoracoscopy should be considered when clinical or imaging suspicion remains significant. Further investigations should be guided by the suspected underlying disease.
{Morphological - Pleural Effusion with Adjacent Pulmonary Consolidation - Possible Etiological (Parapneumonic / Infective / Tuberculous Pleural Effusion)}
Finding: Ultrasound examination of the [right/left] hemithorax demonstrates a pleural fluid collection associated with an adjacent subpleural region of pulmonary consolidation. The consolidated lung demonstrates a tissue-like echotexture with loss of the normal aerated lung appearance. Echogenic air bronchograms and/or fluid bronchograms may be identified within the consolidated parenchyma. The adjacent pleural fluid may be anechoic or demonstrate internal echoes and septations. Associated pleural thickening and additional pulmonary abnormalities should be evaluated.
Impression: [right/left]-Sided pleural effusion with adjacent pulmonary consolidation. The findings favor a parapneumonic effusion in the appropriate clinical setting, particularly when accompanied by fever, cough, and inflammatory symptoms. Other infective causes, including tuberculosis, and noninfective causes of consolidation should be considered according to the clinical presentation.
Recommendation: Clinical correlation with symptoms, physical examination, CBC, CRP, and other relevant inflammatory markers is recommended. Chest radiography may be useful to assess the extent of pulmonary involvement. CT thorax may be considered when the diagnosis is uncertain, complications are suspected, or the clinical response is unsatisfactory. Diagnostic ultrasound-guided thoracentesis should be considered when the effusion is of sufficient size and clinical features suggest a complicated parapneumonic effusion. Pleural fluid pH, glucose, LDH, protein, Gram stain, and bacterial culture may help guide management. Follow-up chest ultrasonography or radiography may be performed to assess treatment response.
{Morphological - Pleural Effusion with Compressive Atelectasis - Possible Etiological (Transudative / Exudative / Malignant / Parapneumonic Pleural Effusion)}
Finding: Ultrasound examination of the [right/left] hemithorax demonstrates a pleural fluid collection associated with passive compression of the adjacent lung parenchyma. The compressed lung appears as a partially collapsed, tissue-like structure projecting into the pleural fluid. The atelectatic lung may demonstrate respiratory movement within the fluid collection. The degree of pulmonary compression should be assessed in relation to the size of the effusion. Internal echoes, septations, pleural thickening, and associated pulmonary abnormalities should also be evaluated.
Impression: [right/left]-Sided pleural effusion with associated passive compressive atelectasis of the adjacent lung. The findings indicate secondary pulmonary compression related to the pleural fluid collection. The sonographic appearance does not establish the underlying etiology, which may be transudative, exudative, parapneumonic, or malignant depending on the clinical context.
Recommendation: Clinical correlation with respiratory symptoms, oxygenation status, and relevant underlying systemic or pulmonary conditions is recommended. Chest radiography or CT thorax may be considered when additional assessment of pulmonary expansion or underlying lung pathology is required. Diagnostic thoracentesis should be considered for an unexplained effusion when clinically indicated. Therapeutic ultrasound-guided thoracentesis may be appropriate in symptomatic patients with a sufficiently large effusion, following assessment of procedural risks and benefits. Follow-up imaging may be performed to evaluate resolution of the effusion and re-expansion of the compressed lung.
{Morphological - Septated Pleural Effusion - Possible Etiological (Complicated Parapneumonic / Empyema / Tuberculous / Chronic Inflammatory Pleural Effusion)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a pleural fluid collection containing multiple echogenic internal septations or fibrinous strands traversing the fluid space. The septations divide the effusion into partially communicating compartments. The intervening fluid may appear anechoic or contain low-level internal echoes. The thickness and distribution of the septations should be documented. Associated pleural thickening, loculation, and adjacent compressive pulmonary changes may be present.
Impression: Septated [right/left]-sided pleural effusion. The appearance suggests an organized pleural fluid collection and raises concern for a complicated parapneumonic effusion or empyema in the appropriate clinical setting. Tuberculous pleuritis and other chronic inflammatory pleural conditions remain possible differential considerations.
Recommendation: Clinical correlation with inflammatory symptoms, CBC, CRP, and other relevant investigations is recommended. Diagnostic ultrasound-guided pleural fluid sampling should be considered when clinically indicated. Pleural fluid biochemical analysis, including pH, glucose, protein, and LDH, together with microbiological testing, may help determine the nature of the effusion. Additional tuberculosis-directed testing may be appropriate when clinically suspected. Contrast-enhanced CT thorax may be useful when further assessment of loculation, pleural organization, or associated pulmonary disease is required. Specialist evaluation is recommended if a complicated infective pleural collection is suspected, as drainage or other intervention may be necessary.
{Morphological - Complex Pleural Effusion - Possible Etiological (Exudative / Infective / Hemorrhagic / Malignant / Tuberculous Pleural Effusion)}
Finding: Ultrasound examination of the [right/left] hemithorax demonstrates a complex pleural fluid collection characterized by heterogeneous internal echogenicity, with variable low-level echoes, echogenic debris, and/or internal fibrinous strands. The collection may contain septations or demonstrate partial loculation. Associated pleural thickening, pleural nodularity, and adjacent pulmonary abnormalities should be assessed. The sonographic appearance differs from that of a simple anechoic pleural effusion.
Impression: Complex [right/left]-sided pleural effusion. The appearance is nonspecific but raises the possibility of an exudative pleural process, including infective, hemorrhagic, malignant, or tuberculous etiologies. Further clinical and laboratory evaluation is required for etiological characterization.
Recommendation: Clinical correlation with presenting symptoms, relevant medical history, CBC, CRP, and other appropriate laboratory investigations is recommended. Chest radiography or contrast-enhanced CT thorax may be considered to evaluate associated pulmonary or pleural pathology. Diagnostic ultrasound-guided thoracentesis with pleural fluid biochemical, microbiological, and cytological analysis should be considered when clinically indicated. Additional investigations for tuberculosis or malignancy should be guided by the clinical presentation and imaging findings. Follow-up ultrasonography may be performed to monitor interval changes or response to treatment.
{Morphological - Encysted Pleural Effusion - Possible Etiological (Complicated Parapneumonic / Empyema / Tuberculous / Post-Inflammatory Pleural Effusion)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a well-defined, localized pleural fluid collection confined to a restricted compartment of the pleural cavity. The collection demonstrates an encysted configuration, with limited redistribution of fluid and margins partially defined by adjacent pleural surfaces or adhesions. The internal fluid may be anechoic or contain variable echogenic debris and septations. Associated pleural thickening and adjacent compressive pulmonary changes may be present.
Impression: Encysted [right/left]-sided pleural effusion. The findings suggest a localized, compartmentalized pleural fluid collection, which may occur in complicated parapneumonic effusion, empyema, tuberculous pleuritis, or post-inflammatory pleural adhesions. The underlying etiology remains indeterminate on sonographic morphology alone.
Recommendation: Clinical correlation with presenting symptoms, medical history, and relevant inflammatory markers is recommended. Contrast-enhanced CT thorax may be considered to define the location, extent, and relationship of the collection to adjacent pleural and pulmonary structures. Diagnostic ultrasound-guided aspiration may be considered when the collection is safely accessible and sampling is clinically indicated. Pleural fluid biochemical, microbiological, and cytological analysis should be performed as appropriate. Respiratory or pleural specialist assessment is advised when a complicated infective collection is suspected or drainage is being considered. Follow-up ultrasonography may be used to evaluate interval changes following treatment.
Empyema (pyothorax)
{Morphological - Stage I: Exudative Stage -
Simple or Mildly Complex Non-Septated Pleural Collection -
Possible Etiological
(Early Empyema / Acute Parapneumonic Pleural Infection)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a [small/moderate/large] pleural fluid collection demonstrating predominantly anechoic to mildly echogenic internal contents. The collection appears relatively free-flowing, without significant internal septations, fibrinous strands, or loculations. Mild adjacent pleural thickening may be present. The underlying lung demonstrates [normal expansion / mild compressive atelectatic changes]. No definite organized pleural peel is identified. The maximum pleural fluid separation measures approximately [___] mm, with an estimated fluid volume of [___] mL, where applicable.
Impression: [right/left]-sided simple to mildly complex non-septated pleural effusion. In the appropriate clinical setting, the findings may represent an early exudative-stage parapneumonic effusion or developing empyema (Stage I). The sonographic appearance is nonspecific and may overlap with other transudative or exudative pleural effusions. Empyema cannot be confirmed or excluded based on ultrasound morphology alone.
Recommendation: Clinical correlation with fever, respiratory symptoms, medical history, and inflammatory markers is recommended. Diagnostic ultrasound-guided thoracentesis is advised when pleural infection is clinically suspected and the collection is safely accessible. Pleural fluid analysis should include pH, glucose, LDH, protein, Gram stain, bacterial culture, and additional investigations as clinically indicated. Contrast-enhanced CT thorax may be considered when associated pneumonia, pleural complications, or alternative pathology requires further evaluation. Prompt respiratory or pleural specialist assessment is recommended when pleural infection is suspected. Follow-up ultrasonography may be performed to assess interval progression, development of septations, or response to treatment.
{Morphological - Stage II: Fibrinopurulent Stage -
Complex Septated and Multiloculated Pleural Collection
with Echogenic Debris and Fibrinous Strands -
Possible Etiological
(Fibrinopurulent Empyema / Complicated Parapneumonic Infection)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a [moderate/large] complex pleural fluid collection demonstrating heterogeneous internal echogenicity with multiple fine to thick echogenic septations, fibrinous strands, and suspended internal debris. The collection demonstrates a multiloculated configuration, with multiple partially communicating or non-communicating fluid compartments. Internal echogenic particulate material is noted, suggestive of inflammatory or purulent contents. Associated visceral and parietal pleural thickening is [present/absent]. The adjacent lung demonstrates compressive atelectatic changes with reduced expansion. No definite mature fibrous pleural peel is identified. The largest loculated compartment measures approximately [___ × ___ × ___] cm.
Impression: Complex septated and multiloculated [right/left]-sided pleural collection. In the appropriate clinical setting, the findings are highly suspicious for fibrinopurulent-stage pleural infection (Stage II empyema). Associated pleural thickening and adjacent compressive pulmonary atelectatic changes are noted. The differential diagnosis includes complicated parapneumonic effusion, tuberculous pleuritis, hemorrhagic pleural collection, and less commonly malignant pleural effusion. Definitive etiological diagnosis requires clinical and pleural fluid correlation.
Recommendation: Prompt respiratory or pleural specialist assessment is recommended due to the complex septated and multiloculated nature of the collection. Ultrasound-guided diagnostic aspiration should be considered when safely accessible, with pleural fluid biochemical and microbiological analysis. Pleural fluid investigations should include pH, glucose, LDH, Gram stain, bacterial culture, and additional tests as clinically indicated. Contrast-enhanced CT thorax is recommended when necessary to assess the extent of loculations, pleural thickening, underlying pulmonary infection, and associated complications. Image-guided intercostal chest drainage should be considered when pleural infection is confirmed or strongly suspected. Intrapleural fibrinolytic therapy (tPA/DNase) or video-assisted thoracoscopic surgery (VATS) may be considered in selected patients with inadequate drainage or persistent pleural infection. Follow-up ultrasonography is recommended to assess residual loculations and treatment response.
{Morphological - Stage III: Organizing Stage -
Thick-Walled Loculated Pleural Collection with
Marked Pleural Thickening, Fibrous Pleural Peel,
and Restricted Lung Expansion -
Possible Etiological
(Chronic Organizing Empyema / Trapped Lung / Fibrothorax)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a complex, predominantly loculated pleural collection demonstrating heterogeneous echogenic contents with internal debris, thick septations, and organized fibrinous material. Marked thickening of the visceral and parietal pleural surfaces is noted, with formation of a thick echogenic pleural rind or fibrous peel surrounding the collection. The pleural collection demonstrates an organized, encapsulated configuration with limited mobility of the internal contents. The adjacent lung appears compressed and demonstrates markedly restricted expansion during respiration, raising suspicion for underlying non-expandable or trapped lung. Associated pleural adhesions and reduced pleural sliding may be present. The maximum pleural thickness measures approximately [___] mm. The residual organized pleural collection measures approximately [___ × ___ × ___] cm.
Impression: Chronic complex loculated [right/left]-sided pleural collection with marked pleural thickening and echogenic fibrous pleural peel. In the appropriate clinical setting, the findings are suggestive of organizing-stage pleural infection (Stage III empyema). Associated restricted expansion of the adjacent lung raises suspicion for non-expandable or trapped lung. Chronic post-infective pleural fibrosis, tuberculous pleuritis, and other causes of fibrothorax should be considered in the differential diagnosis. The presence and extent of a fibrous pleural peel and underlying lung entrapment require further clinical and cross-sectional imaging correlation.
Recommendation: Respiratory and thoracic surgical consultation is recommended for assessment of chronic organized pleural disease and restricted lung expansion.
Pneumothorax
{Morphological - Absent Lung Sliding with Preserved A-Line Pattern -
Possible Etiological
(Pneumothorax / Pleural Air Accumulation)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals absence of normal lung sliding along the visualized pleural interface in the [anterior/lateral/ posterior] thoracic region. Multiple horizontal reverberation artifacts (A-lines) are identified deep to the pleural line. No definite vertical B-line artifacts are demonstrated within the affected scanning region. The pleural line appears relatively static during respiration, without appreciable to-and-fro movement. The lung point sign is [identified/not identified]. The abnormal findings involve approximately [one/multiple] intercostal scanning regions.
Impression: Absent lung sliding with preserved A-line pattern in the [right/left] hemithorax. The findings are suspicious for pneumothorax in the appropriate clinical setting. However, absent lung sliding alone is not specific for pneumothorax and may also occur with pleural adhesions, severe pulmonary hyperinflation, mainstem bronchial intubation, apnea, or markedly reduced regional ventilation. The presence of a definite lung point sign would provide stronger sonographic evidence of pneumothorax.
Recommendation: Immediate clinical correlation with respiratory symptoms, oxygen saturation, hemodynamic status, and relevant medical history is recommended.
{Morphological - Barcode / Stratosphere Sign on M-Mode -
Absence of Normal Seashore Pattern -
Possible Etiological
(Pneumothorax / Loss of Pleural Sliding)}
Finding: Ultrasound examination of the [right/left] hemithorax demonstrates absence of normal pleural sliding at the examined intercostal region. M-mode interrogation through the pleural interface reveals multiple parallel horizontal echogenic lines extending both above and below the pleural line, producing a characteristic barcode or stratosphere appearance. The normal granular seashore pattern is absent within the affected scanning region. On B-mode examination, horizontal A-line reverberation artifacts are [present/absent]. Vertical B-line artifacts are not demonstrated at the examined pleural interface. The lung point sign is [present/not demonstrated].
Impression: M-mode barcode / stratosphere sign in the [right/left] hemithorax, indicating absence of detectable pleural sliding.
Recommendation: Clinical correlation with respiratory symptoms, oxygen saturation, and hemodynamic status is recommended.
{Morphological - Lung Point Sign -
Alternating Sliding and Non-Sliding Pleural Interface -
Possible Etiological
(Pneumothorax / Localized Boundary of Pleural Air)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a focal transition between regions demonstrating normal lung sliding and adjacent regions showing absent lung sliding. At the transition zone, intermittent appearance and disappearance of normal pleural sliding are observed during respiration. This dynamic transition produces the characteristic lung point sign. On M-mode interrogation, alternating seashore and barcode / stratosphere patterns are demonstrated at the transition point. Horizontal A-line artifacts are noted within the non-sliding region. The lung point is identified at the [anterior/lateral/posterior] thoracic region at approximately the [___] intercostal space.
Impression: Positive lung point sign in the [right/left] hemithorax.
Recommendation: Prompt clinical assessment is recommended to determine the severity of pneumothorax and the need for intervention.
{Morphological - Preserved A-Lines with Absent B-Lines -
Predominant Horizontal Reverberation Pattern -
Possible Etiological
(Pneumothorax / Pleural Air Interposition)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals multiple regularly spaced horizontal reverberation artifacts (A-lines) extending deep to the pleural interface. No vertical B-line artifacts are demonstrated within the examined scanning region. The pleural line appears [regular/irregular]. Associated lung sliding is [present/absent]. M-mode examination demonstrates a [seashore/barcode] pattern. The lung point sign is [present/not demonstrated]. No focal subpleural consolidation is identified within the examined region.
Impression: Predominant A-line pattern with absence of B-line artifacts in the [right/left] hemithorax. This pattern may be observed in pneumothorax, particularly when associated with absent lung sliding. However, preserved A-lines and absent B-lines are nonspecific findings and may also occur in normally aerated lungs or pulmonary hyperinflation. If normal lung sliding is preserved, pneumothorax is unlikely at the examined site. The findings should not be interpreted as diagnostic of pneumothorax in isolation.
Recommendation: Correlation with real-time pleural sliding is essential. Systematic ultrasound evaluation of multiple thoracic regions is recommended to assess for absent lung sliding, lung point, and other supporting signs. M-mode examination may be used as an additional assessment of pleural motion. Chest radiography may be considered when pneumothorax remains clinically suspected. CT thorax may be considered when ultrasound findings are inconclusive or when associated thoracic abnormalities require evaluation. Clinical management should be based on the combined sonographic and clinical findings.
{Morphological - Focal Absence of Lung Sliding with
Regional A-Line Dominance and Adjacent Preserved Pleural Motion -
Possible Etiological
(Loculated Pneumothorax / Post-Inflammatory Pleural Adhesions /
Postoperative Pleural Air Collection)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals focal absence of normal lung sliding within the [anterior/lateral/posterior] thoracic region. The affected region demonstrates prominent horizontal A-line reverberation artifacts without definite B-line artifacts. Adjacent scanning regions demonstrate [preserved/reduced] lung sliding. A focal transition between sliding and non-sliding pleural interfaces is [identified/not identified]. Associated pleural thickening or irregularity is [present/absent]. The abnormality appears confined to a localized thoracic region. A discrete pleural air pocket cannot be directly delineated or reliably measured using conventional ultrasound.
Impression: Focal absence of lung sliding with regional A-line dominance in the [right/left] hemithorax.
Recommendation: Clinical correlation with previous thoracic surgery, trauma, pleural infection, and pleural interventions is recommended.
{Morphological - Pleural Air–Fluid Interface with
Associated Pleural Fluid Collection and Absent Lung Sliding -
Possible Etiological
(Hydropneumothorax / Traumatic or Iatrogenic Pleural Air /
Bronchopleural Fistula / Infective Pleural Collection)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a pleural fluid collection demonstrating [anechoic/hypoechoic/complex echogenic] contents. A distinct transition is identified between the dependent pleural fluid collection and the adjacent region demonstrating air-related reverberation artifacts. Within the air-containing region, normal lung sliding is [absent/not assessable]. Horizontal A-line artifacts and prominent reverberation or acoustic shadowing are demonstrated. At the air–fluid interface, intermittent respiratory movement of the boundary may be observed. A dynamic hydro-point sign is [identified/not identified]. The underlying lung demonstrates [compressive atelectatic changes / restricted expansion / no definite abnormality]. Associated pleural septations or echogenic debris are [present/absent]. The pleural fluid component measures approximately [___ × ___ × ___] cm.
Impression: Combined pleural fluid collection and air-related sonographic artifacts in the [right/left] hemithorax. When a definite pleural air–fluid transition or hydro-point sign is demonstrated, the findings are suggestive of [right/left]-sided hydropneumothorax. Possible etiological associations include thoracic trauma, recent pleural intervention, bronchopleural fistula, postoperative changes, or pleural infection. The underlying cause cannot be reliably established from ultrasound morphology alone. The presence of complex pleural fluid may raise suspicion for an associated infective or hemorrhagic component.
Recommendation: Prompt clinical assessment with correlation of respiratory symptoms, oxygen saturation, hemodynamic status, and relevant medical or procedural history is recommended. Chest radiography may be performed to confirm the presence of pleural air and fluid in clinically stable patients. CT thorax is recommended when necessary to define the extent of hydropneumothorax, underlying pulmonary abnormalities, and possible bronchopleural communication.
Lung consolidation
{Morphological - Small Focal Subpleural Hypoechoic Consolidation
with Localized Pleural Line Interruption and Loss of
Normal A-Line Artifacts -
Possible Etiological
(Early Pneumonia / Bronchopneumonia /
Peripheral Atelectasis / Pulmonary Infarction)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a focal subpleural hypoechoic consolidation within the [anterior/lateral/posterior/basal] lung region. The lesion measures approximately [__ × __] mm. The affected pulmonary region demonstrates localized loss of normal A-line reverberation artifacts. The overlying pleural line appears [irregular/thickened/interrupted]. Internal air bronchograms are [present/absent]. Associated focal B-line artifacts are [present/absent]. Adjacent lung sliding is [preserved/reduced]. Associated pleural effusion is [present/absent].
Impression: Focal subpleural pulmonary consolidation in the [right/left] hemithorax.
Recommendation: Clinical correlation with respiratory symptoms, inflammatory markers, and suspected pulmonary infection or infarction is recommended. Chest radiography or CT thorax may be considered when clinically indicated.
{Morphological - Homogeneous Tissue-Like Pulmonary
Consolidation with Hepatization of Lung Parenchyma
and Loss of Normal Aeration Artifacts -
Possible Etiological
(Lobar Pneumonia / Extensive Alveolar Consolidation /
Obstructive Atelectasis / Compression Atelectasis)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a region of tissue-like pulmonary echotexture within the [upper/middle/lower] lung zone. The affected pulmonary parenchyma demonstrates homogeneous hypoechoic echotexture resembling hepatic parenchyma (lung hepatization). Normal A-line artifacts are absent within the affected region. Internal air bronchograms are [present/absent]. The consolidation measures approximately [__ × __] mm. Associated pleural fluid is [present/absent].
Impression: Tissue-like pulmonary consolidation with hepatization in the [right/left] lung.
Recommendation: Correlation with clinical findings and chest radiography is recommended to differentiate pneumonic consolidation from atelectasis.
{Morphological - Irregular Subpleural Tissue-Like
Consolidation with Fragmented Hyperechoic Deep
Boundary Forming a Characteristic Shred Sign -
Possible Etiological
(Bronchopneumonia / Patchy Pneumonia /
Inflammatory Pulmonary Consolidation)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals an irregular subpleural hypoechoic consolidation within the [anterior/lateral/posterior] thoracic region. The deep margin of the consolidation demonstrates an irregular fragmented hyperechoic interface with adjacent aerated pulmonary parenchyma. This produces a characteristic shred sign. The lesion measures approximately [__ × __] mm. Internal air bronchograms are [present/absent]. The overlying pleural line appears [normal/irregular/thickened]. Adjacent B-line artifacts are [present/absent].
Impression: Irregular subpleural pulmonary consolidation demonstrating a characteristic shred sign in the [right/left] lung.
Recommendation: Clinical correlation for an underlying infective or inflammatory pulmonary process is recommended.
{Morphological - Tissue-Like Pulmonary Consolidation
Containing Multiple Dynamic Hyperechoic Air
Bronchograms Demonstrating Respiratory-Dependent
Centrifugal Movement -
Possible Etiological
(Bacterial Pneumonia / Aspiration Pneumonia /
Nonobstructive Pneumonic Consolidation)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals tissue-like pulmonary consolidation within the [upper/middle/lower] lung region. Multiple hyperechoic punctate and linear air bronchograms are identified within the consolidated parenchyma. These echogenic bronchograms demonstrate respiratory-dependent movement, with centrifugal displacement during inspiration. The consolidation measures approximately [__ × __] mm. Associated pleural irregularity is [present/absent]. Associated pleural effusion is [present/absent].
Impression: Pulmonary consolidation demonstrating dynamic air bronchograms in the [right/left] lung. The sonographic appearance favors pneumonic consolidation.
Recommendation: Correlation with clinical symptoms, inflammatory markers, and microbiological investigations is recommended.
{Morphological - Tissue-Like Pulmonary Consolidation
Containing Static Hyperechoic Air Bronchograms
Without Appreciable Respiratory-Dependent Movement -
Possible Etiological
(Obstructive Atelectasis / Compression Atelectasis /
Pneumonic Consolidation)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a tissue-like pulmonary consolidation within the [anterior/lateral/posterior/basal] region. Multiple hyperechoic punctate or linear air bronchograms are visualized within the consolidated lung. The bronchograms remain relatively stationary during respiratory movements. Dynamic centrifugal movement is not demonstrated. Associated pulmonary volume reduction is [present/absent]. Adjacent pleural effusion is [present/absent].
Impression: Pulmonary consolidation with static air bronchograms in the [right/left] lung. The appearance may represent atelectatic or pneumonic consolidation.
Recommendation: Correlation with clinical findings and chest imaging is recommended. Assessment for bronchial obstruction may be considered when clinically suspected.
{Morphological - Tissue-Like Pulmonary Consolidation
Containing Anechoic or Hypoechoic Branching
Tubular Structures Representing Fluid Bronchograms -
Possible Etiological
(Postobstructive Pneumonia / Bronchial Obstruction /
Obstructive Atelectasis / Severe Pneumonia)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a tissue-like pulmonary consolidation within the [upper/middle/lower] lung region. Multiple branching anechoic or hypoechoic tubular structures are identified within the consolidated pulmonary parenchyma. These structures demonstrate a fluid bronchogram appearance. Internal Doppler vascular flow within the branching tubular structures is [absent/present]. Associated air bronchograms are [present/absent]. The consolidation measures approximately [__ × __] mm.
Impression: Pulmonary consolidation demonstrating internal fluid bronchograms in the [right/left] lung.
Recommendation: Clinical correlation and further chest imaging are recommended when bronchial obstruction or postobstructive infection is suspected.
{Morphological - Extensive Tissue-Like Pulmonary
Consolidation Involving a Large Lung Region
with Loss of Normal Aeration Artifacts -
Possible Etiological
(Lobar Pneumonia / Extensive Alveolar Consolidation /
Complete Atelectasis)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals extensive tissue-like pulmonary consolidation involving the [upper/middle/lower] lung region. The affected parenchyma demonstrates relatively homogeneous hepatic-like echotexture. Normal A-line reverberation artifacts are absent throughout the visualized consolidated region. The deep boundary appears [smooth/irregular/not completely visualized]. Internal air bronchograms are [present/absent]. Associated pleural effusion is [present/absent].
Impression: Extensive pulmonary consolidation in the [right/left] lung.
Recommendation: Chest radiography or CT thorax may be considered to assess the full extent of pulmonary involvement and differentiate consolidation from atelectasis.
{Morphological - Multiple Patchy Irregular Subpleural
Hypoechoic Consolidations with Intervening Aerated
Lung Parenchyma -
Possible Etiological
(Bronchopneumonia / Multifocal Pneumonia /
Viral Pneumonitis / Multifocal Pulmonary Infarction)}
Finding: Ultrasound examination of the [right/left/bilateral] hemithorax reveals multiple discrete irregular subpleural hypoechoic consolidations. The lesions are distributed within the [anterior/lateral/posterior/basal] lung regions. Individual consolidations measure approximately [__ to __] mm. Intervening regions demonstrate [preserved/reduced] pulmonary aeration. Associated focal B-line artifacts are [present/absent]. The overlying pleural line appears [normal/irregular/thickened]. Internal air bronchograms are [present/absent].
Impression: Patchy multifocal subpleural pulmonary consolidations involving the [right/left/bilateral] lung regions.
Recommendation: Clinical correlation for multifocal infective or inflammatory pulmonary pathology is recommended.
{Morphological - Peripheral Pleural-Based Triangular
or Wedge-Shaped Hypoechoic Pulmonary Consolidation
with Variable Internal Vascularity -
Possible Etiological
(Pulmonary Infarction / Peripheral Pneumonia /
Focal Atelectasis)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a peripheral pleural-based wedge-shaped hypoechoic consolidation within the [anterior/lateral/posterior/basal] region. The lesion measures approximately [__ × __] mm. The consolidation demonstrates a triangular configuration with its base directed toward the pleural surface. Internal air bronchograms are [present/absent]. Color Doppler examination demonstrates [preserved/reduced/absent detectable] internal vascularity. Associated localized pleural effusion is [present/absent].
Impression: Peripheral wedge-shaped subpleural pulmonary consolidation in the [right/left] lung. Pulmonary infarction is a consideration in the appropriate clinical setting.
Recommendation: Urgent clinical assessment for pulmonary embolism is recommended when supported by symptoms and risk factors. CT pulmonary angiography may be considered according to clinical probability and established diagnostic pathways.
{Morphological - Focal Rounded or Oval Tissue-Like
Pulmonary Consolidation with Relatively Well-Defined
Margins and Variable Internal Air Bronchograms -
Possible Etiological
(Round Pneumonia / Organizing Pneumonia /
Rounded Atelectasis / Peripheral Pulmonary Neoplasm)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a focal rounded or oval hypoechoic tissue-like pulmonary lesion within the [anterior/lateral/posterior] region. The lesion measures approximately [__ × __] mm. The margins appear [well-defined/partially irregular]. Internal air bronchograms are [present/absent]. Color Doppler demonstrates [preserved/reduced/absent detectable] internal vascularity. Associated pleural irregularity is [present/absent].
Impression: Rounded peripheral pulmonary consolidation-like lesion in the [right/left] lung.
Recommendation: Correlation with clinical history and chest radiography or CT thorax is recommended to distinguish infective consolidation from other focal pulmonary lesions.
{Morphological - Dependent Tissue-Like Pulmonary
Consolidation Adjacent to Pleural Fluid with
Compressed Lung Architecture and Respiratory
Movement of Atelectatic Parenchyma -
Possible Etiological
(Pleural Effusion-Related Compression Atelectasis /
Hemothorax / Large Pleural Fluid Collection)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a dependent tissue-like pulmonary consolidation adjacent to a pleural fluid collection. The consolidated lung demonstrates compressed parenchymal architecture. Respiratory-dependent movement of the atelectatic lung within the pleural fluid is [present/absent]. The adjacent pleural fluid appears [anechoic/complex/septated]. Internal air bronchograms are [present/absent]. The consolidated region measures approximately [__ × __] mm.
Impression: Dependent pulmonary consolidation with features suggestive of compression atelectasis associated with pleural effusion.
Recommendation: Clinical correlation and evaluation of the underlying pleural effusion are recommended.
{Morphological - Homogeneous Tissue-Like Pulmonary
Consolidation with Regional Volume Reduction
and Static or Absent Air Bronchograms -
Possible Etiological
(Mucus Plugging / Endobronchial Obstruction /
Bronchial Neoplasm / Postoperative Atelectasis)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a homogeneous tissue-like pulmonary consolidation within the [upper/middle/lower] lung region. The consolidated parenchyma demonstrates reduced regional aeration. Associated regional pulmonary volume reduction is [suspected/not evident]. Internal air bronchograms are [absent/static]. Dynamic air bronchograms are not demonstrated. Associated pleural fluid is [present/absent].
Impression: Pulmonary consolidation with features that may represent obstructive atelectasis in the [right/left] lung.
Recommendation: Clinical correlation and chest imaging are recommended. Further assessment for endobronchial obstruction may be considered when indicated.
{Morphological - Heterogeneous Tissue-Like Pulmonary
Consolidation Containing Multiple Irregular
Hypoechoic or Anechoic Nonvascular Areas -
Possible Etiological
(Necrotizing Pneumonia / Severe Bacterial Pneumonia /
Pulmonary Parenchymal Necrosis)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a heterogeneous tissue-like pulmonary consolidation within the [upper/middle/lower] lung region. Multiple irregular hypoechoic or anechoic areas are identified within the consolidated parenchyma. These regions demonstrate [reduced/absent detectable] internal vascular flow on Doppler examination. The surrounding consolidated tissue demonstrates [preserved/reduced] vascularity. Associated pleural effusion is [present/absent].
Impression: Heterogeneous pulmonary consolidation with internal nonvascular hypoechoic areas, suspicious for necrotizing pulmonary infection.
Recommendation: Prompt clinical evaluation and contrast-enhanced CT thorax are recommended when necrotizing pneumonia is suspected.
{Morphological - Heterogeneous Pulmonary Consolidation
Containing Irregular Cavitary Spaces with Internal
Fluid, Echogenic Debris, or Gas Reverberation Artifacts -
Possible Etiological
(Lung Abscess / Cavitating Pneumonia /
Pulmonary Tuberculosis / Cavitating Pulmonary Neoplasm)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a heterogeneous pulmonary consolidation within the [upper/middle/lower] lung region. An internal irregular cavitary area measuring approximately [__ × __] mm is identified. The cavity demonstrates [anechoic fluid/internal echogenic debris/ gas-related reverberation artifacts]. The surrounding pulmonary parenchyma demonstrates tissue-like consolidation. Color Doppler examination demonstrates [absent/preserved] vascularity within the cavity and [preserved/reduced] vascularity in the surrounding tissue. Associated pleural effusion is [present/absent].
Impression: Cavitary pulmonary consolidation in the [right/left] lung. The appearance raises concern for a cavitating infective process.
Recommendation: Clinical correlation and CT thorax are recommended for further characterization of the cavitary pulmonary lesion.
{Morphological - Subpleural Tissue-Like Pulmonary
Consolidation Associated with Adjacent Pleural
Fluid Collection and Variable Internal Air Bronchograms -
Possible Etiological
(Pneumonia with Parapneumonic Effusion /
Compression Atelectasis /
Empyema-Associated Pulmonary Consolidation)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a tissue-like pulmonary consolidation within the [posterior/basal/lateral] lung region. An adjacent pleural fluid collection is identified. The pleural fluid appears [anechoic/complex/septated]. The consolidated pulmonary parenchyma demonstrates [homogeneous/heterogeneous] echotexture. Internal air bronchograms are [present/absent]. The consolidated region measures approximately [__ × __] mm.
Impression: Pulmonary consolidation associated with ipsilateral pleural effusion.
Recommendation: Clinical correlation for pneumonia, parapneumonic effusion, and compression atelectasis is recommended. Pleural fluid assessment or sampling may be considered when clinically indicated.
{Morphological - Focal Subpleural Hypoechoic
Consolidation with Thickened Irregular Pleural
Line and Adjacent Focal B-Line Artifacts -
Possible Etiological
(Inflammatory Pneumonia / Viral Pneumonitis /
Organizing Pneumonia / Peripheral Lung Inflammation)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a focal subpleural hypoechoic consolidation within the [anterior/lateral/posterior] region. The overlying pleural line demonstrates irregularity and focal thickening. Multiple adjacent vertical B-line artifacts are identified. Normal A-line artifacts are reduced within the affected region. The consolidation measures approximately [__ × __] mm. Internal air bronchograms are [present/absent].
Impression: Focal subpleural consolidation with associated pleural line irregularity and regional B-line artifacts.
Recommendation: Clinical correlation for an underlying infective or inflammatory pulmonary process is recommended.
{Morphological - Tissue-Like Pulmonary Consolidation
Demonstrating Preserved Branching Intralesional
Vascular Flow on Color Doppler Examination -
Possible Etiological
(Non-Necrotic Pneumonia / Inflammatory Consolidation /
Atelectatic Pulmonary Parenchyma)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a tissue-like pulmonary consolidation within the [upper/middle/lower] lung region. Color Doppler examination demonstrates branching vascular flow signals within the consolidated parenchyma. The vascular architecture appears [relatively preserved/distorted]. Internal air bronchograms are [present/absent]. No definite internal avascular necrotic area is identified. Associated pleural effusion is [present/absent].
Impression: Pulmonary consolidation with preserved intralesional vascularity in the [right/left] lung.
Recommendation: Correlation with clinical findings and other sonographic features is recommended to differentiate pneumonic consolidation from atelectasis.
{Morphological - Focal Hypoechoic or Heterogeneous
Pulmonary Consolidation Demonstrating Reduced
or Absent Detectable Internal Doppler Vascularity -
Possible Etiological
(Pulmonary Infarction / Necrotizing Pneumonia /
Pulmonary Abscess)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a focal hypoechoic pulmonary consolidation within the [anterior/lateral/posterior/basal] region. The lesion measures approximately [__ × __] mm. Color Doppler examination demonstrates [markedly reduced/absent detectable] internal vascular flow. The lesion margins appear [well-defined/irregular]. Internal air bronchograms are [present/absent]. Associated pleural fluid is [present/absent].
Impression: Focal pulmonary consolidation with reduced or absent detectable internal vascularity. Pulmonary infarction or necrotizing infection may be considered in the appropriate clinical context.
Recommendation: Clinical assessment and further cross-sectional imaging are recommended when pulmonary infarction or necrotizing infection is suspected.
{Morphological - Gravity-Dependent Basal Tissue-Like
Pulmonary Consolidation with Reduced Aeration
and Variable Internal Air Bronchograms -
Possible Etiological
(Dependent Atelectasis / Aspiration Pneumonia /
Basal Pneumonia / Compression Atelectasis)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a dependent tissue-like pulmonary consolidation within the posterior basal region. The consolidated parenchyma demonstrates [homogeneous/heterogeneous] echotexture. Internal air bronchograms are [present/absent]. The bronchograms demonstrate [dynamic/static/no appreciable] movement. Associated pleural fluid is [present/absent]. Regional pulmonary aeration is reduced.
Impression: Dependent basal pulmonary consolidation in the [right/left] lung.
Recommendation: Clinical correlation for dependent atelectasis, aspiration, or basal pneumonia is recommended.
{Morphological - Focal Subpleural Tissue-Like
Consolidation Surrounded by Multiple Confluent
B-Line Artifacts with Irregular Pleural Line
and Regional Loss of Normal A-Line Pattern -
Possible Etiological
(Bronchopneumonia / Viral Pneumonitis /
Organizing Pneumonia / Focal Inflammatory Lung Injury)}
Finding: Ultrasound examination of the [right/left] hemithorax reveals a focal subpleural hypoechoic consolidation within the [anterior/lateral/posterior] region. Multiple confluent vertical B-line artifacts arise from the adjacent pleural interface. The pleural line appears [irregular/thickened/fragmented]. Normal horizontal A-line artifacts are reduced or absent within the affected region. The consolidation measures approximately [__ × __] mm. Internal air bronchograms are [present/absent]. Adjacent lung sliding is [preserved/reduced].
Impression: Focal subpleural pulmonary consolidation associated with regional B-line predominance and pleural line irregularity.
Recommendation: Clinical correlation for an underlying infective or inflammatory pulmonary process is recommended.
