Bedside contrast-enhanced ultrasound: Clinical applications for internal medicine

Point-of-care ultrasound (POCUS) is widely used in Internal Medicine for rapid bedside assessment, but conventional modalities such as B-mode and Doppler provide limited information on tissue microvascular perfusion. Contrast-enhanced ultrasound (CEUS) can address this limitation by enabling real-time visualization of parenchymal and vascular microcirculation through intravenous administration of microbubble contrast agents. The present work will summarize the technical principles, clinical applications, and practical considerations of bedside CEUS in common Internal Medicine scenarios. When performed using contrast-specific imaging, CEUS can be safely administered at the bedside, including patients with renal dysfunction or hemodynamic instability. In selected clinical settings, CEUS may complement conventional POCUS by refining diagnostic interpretation, such as identifying pancreatic necrosis, characterizing abscesses and complicated cholecystitis, differentiating infarction from infection in solid organs, and assessing vascular abnormalities including thrombi or endoleaks. In postoperative or traumatic contexts, CEUS may assist in distinguishing hematomas from abscesses and in detecting active bleeding, supporting timely referral for interventional management. In chronic liver disease, CEUS can help differentiate bland from malignant portal vein thrombosis, with relevant implications for clinical decision-making. Despite these potential advantages, bedside CEUS should not be considered a routine extension of standard POCUS. Its application is limited by operator dependency, acoustic window constraints, and heterogeneous levels of supporting evidence across indications. When applied to focused clinical questions by appropriately trained clinicians and integrated within established diagnostic pathways, CEUS represents a valuable adjunct to bedside ultrasound. Further prospective studies are needed to better define its role in Internal Medicine practice.