Pneumonia Case 001

• This RUQ view shows a small area of basal consolidation.
• The normally reflective aerated lung in the posterior costophrenic angle is lost, and replaced by a tiny pleural effusion surrounding consolidated lung.
• The “spine sign” is seen and is characteristic of basal pathology. The posterior chest wall is usually obscured by air in normal lung above the diaphragm. In this case the spine can be seen and followed cranially above the diaphragm. This is because ultrasound can penetrate the fluid and solid lung, rather than being reflected away completely.

• A small region of basal consolidation is confirmed, with a surrounding pleural effusion.
• The patient’s clinical presentation was consistent with a basal pneumonia and the ultrasound features confirmed this.
• They include consolidated lung, air bronchograms, an irregular “shredded” border between the consolidated and aerated lung, with B-lines at the interface, and an associated small pleural effusion.

Chest X-ray performed after the ultrasound confirms the findings of right lower lobe consolidation.

• This slide is a histological section of bronchopneumonia.
• Air spaces are completely filled with inflammatory cells and exudate.
• This explains why in pneumonia, ultrasound can penetrate the lung parenchyma rather than being reflected away by air.Where air remains within bronchi the characteristic “sonographic air bronchogram” is seen.