[Thoraxsonography--part 2--Subpleural lung lesions]

In many cases of pulmonary diseases extending up to the pleura, ultrasound helps to identify the etiology of the lesion. There are several sonomorphological criteria to differentiate peripheral pulmonary consolidations. The sonomorphology of pneumonic lung infiltration reveals typical changes: bronchoaerogram, fluidobronchogram, parapneumonic effusion, abscess formation. The extent of infiltration is sometimes underestimated due to artefacts. In sonography lung cancers are echopoor, rounded and polypoid, show sharp and serrated margins. The accuracy of ultrasound-guided transcutane biopsy in carcinomas is higher than 90%. The rate of pneumothorax is 2.6%, those requiring drainage are about 1%. Haemoptyses occur 1-2% of the punctures, most commonly in cases of chronic pneumonia. When a pulmonary embolism develops, thoracic sonography in 70-90% reveals subpleural sound-permeable lesions: embolism-related alveolar edemas and hemorrhages--early reperfusionable infarcts and triangular late infarcts. In compression atelectasis there usually is a homogeneous, hyperechoic transformation, shaped like a pointed cap or a wedge.