Advances in Lung Ultrasound

Dear Colleagues,

Because nothing is seen sonographically in the healthy lung, lung ultrasound was discovered late. The detection of pleural effusions has been known for 50 years. On the lung itself, however, it has taken longer.

Reports of sonographic differentiation of peripheral lung consolidations (pneumonia, emboli, tumors, and atelectasis) have also been available for decades. Meanwhile, we know from quite a few meta-analyses that ultrasound replaces chest radiography in the imaging diagnosis of community-acquired pneumonia (sensitivity 90% vs. 75%). This is increasingly true in general practice, emergency departments, and in developing countries. With handheld devices, the transducer is replacing the stethoscope in many issues.

In the era of COVID-19, we need initial computed tomography in moderate and severe forms to assess intrapulmonary involvement. However, because 80% suffer from threatening dorsobasal pneumonia, daily ultrasound examinations, and bedside during rounds for therapy monitoring are sufficient and efficient—no costly patient transports, no unnecessary radiation exposure. Sonography is useful for monitoring reventilation of atelectasis and pneumonia in ventilated patients, as well as during weaning by assessing diaphragmatic motility.

The differentiation of pulmonary edema and exacerbated COPD using B-line imaging by Daniel Lichtenstein was groundbreaking. In the much-cited International Consensus conference of point of care lung ultrasound, guidelines were developed 10 years ago on how to proceed with various symptoms and diagnostic issues. Statements were discussed and elaborated on by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. After the basic studies of the preceding years, there was a rapid development of lung ultrasonography in science and practice.

Prof. Dr. Gebhard Mathis
Guest Editor

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