Ultrasound Case 001

Image 1: Left lower lobe consolidation with prominent air bronchograms and a parapneumonic pleural effusion.

Image 2: Colour Doppler interrogation confirms the pulmonary arterial flow and venous flow.

Left lower lobe pneumonia and parapneumonic effusion.

Clinically the differential diagnosis is broad. Pneumothorax was rapidly excluded. With regard to pulmonary embolism, echo showed a hyperdynamic cardiac state with a normal right ventricle, and pulmonary arterial flow was well preserved.

A large pleural effusion could cause compressive atelectasis of the lower lobe, but in this case the effusion was not very large, and the underlying consolidated lung border did not have the scalloped compressed appearance one sees with the compressive effects of a large effusion.

The underlying lung architecture appears preserved, with air bronchograms and pulmonary vasculature well imaged. No pulmonary abscess nor large tumour is seen. The features are typical for lobar pneumonia with a parapneumonic effusion.

The lack of dynamic air bronchograms could raise the possibility of a proximal obstructive bronchial lesion, although in these situations often the distal lung with its resorptive atelectasis appears less plump and rounded than it does here. Never the less follow up imaging to ensure resolution after appropriate antibiotic therapy is very important.

Lung ultrasound adds to the bedside assessment of a patient but sensitivity and specificity are lacking for many pathologies. It should be integrated into a comprehensive clinical assessment, and used with other imaging to form a complete picture.