Critical care ultrasound has shifted the paradigm of thoracic imaging by enabling the treating physician to acquire and interpret images essential for clinical decision-making, at the bedside, in real-time. Once considered impossible, lung ultrasound based on interpretation of artifacts along with true images, has gained momentum during the last decade, as an integral part of rapid evaluation algorithms for acute respiratory failure, shock and cardiac arrest. Procedural ultrasound image guidance is a standard of care for both common bedside procedures, and advanced procedures within interventional pulmonologist’s (IP’s) scope of practice. From IP’s perspective, the lung, pleural, and chest wall ultrasound expertise is a prerequisite for mastery in pleural drainage techniques and transthoracic biopsies. Another ultrasound application of interest to the IP in the intensive care unit (ICU) setting is during percutaneous dilatational tracheostomy (PDT). As ICU demographics shift towards older and sicker patients, the indications for closed pleural drainage procedures, bedside transthoracic biopsies, and percutaneous dilatational tracheostomies have dramatically increased. Although ultrasound expertise is considered an essential IP operator skill there is no validated curriculum developed to address this component. Further, there is a need for developing an educational tool that matches up with the curriculum and could be integrated real-time with ultrasound-guided procedures.

• Ultrasound
• intensive care unit (ICU)
• interventional pulmonology (IP)
• procedure

• chest ultrasound
• internal medicine
• lung ultrasound
• recommendations

• Algorithms
• Humans
• Infant, Newborn
• Lung/diagnostic imaging
• Lung Diseases/diagnostic imaging
• Neonatology/standards
• Point-of-Care Testing/standards
• Practice Guidelines as Topic
• Ultrasonography/methods

Clinical assessment and workup of patients referred to cardiologists may need an extension to chest disease. This requires more in-depth examination of respiratory co-morbidities due to uncertainty or severity of the clinical presentation. The filter and integration of ecg and echocardiographic information, addressing to the clues of right ventricular impairment, pulmonary embolism and pulmonary hypertension, and other less frequent conditions, such as congenital, inherited and systemic disease, usually allow more timely diagnosis and therapeutic choice. The concurrent use of thoracic ultrasound (TUS) is important, because, despite the evidence of the strict links between cardiac and respiratory medicine, heart and chest US imaging approaches are still separated. Actually, available expertise, knowledge, skills and training and equipment’s suitability are not equally fitting for heart or lung examination and not always already accessible in the same room or facility. Echocardiography is useful for study and monitoring of several respiratory conditions and even detection, so that this is nowadays an established functional complementary tool in pulmonary fibrosis and diffuse interstitial disease diagnosis and monitoring. Extending the approach of the cardiologist to lung and pleura will allow the achievement of information on pleural effusion, even minimal, lung consolidation and pneumothorax. Electrocardiography, pulse oximetry and US equipment are the friendly extension of the physical examination, if their use relies on adequate knowledge and training and on appropriate setting of efficient and working machines. Lacking these premises, overshadowing or misleading artefacts may impair the usefulness of TUS as an imaging procedure.

• Thoracic ultrasound
• Echocardiography
• Congestive heart failure
• Pneumonia
• Pleural effusion
• Cancer
• Pneumothorax
• Clinical risk management

Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound (TUS) with conventional (chest X-rays-) and more advanced imaging procedures (computed tomography and magnetic resonance imaging) implies advantages, limitations and actual problems. Indeed, despite TUS may provide useful imaging of pleura, lung and heart disease, emergency scenarios are currently the most warranted field of application of TUS: Pleural effusion, pneumothorax, lung consolidation. This stems from its role in limited resources subsets; actually, ultrasound is an excellent risk reducing tool, which acts by: (1) increasing diagnostic certainty; (2) shortening time to definitive therapy; and (3) decreasing problems from blind procedures that carry an inherent level of complications. In addition, paediatric and newborn disease are particularly suitable for TUS investigation, aimed at the detection of congenital or acquired chest disease avoiding, limiting or postponing radiological exposure. TUS improves the effectiveness of elective medical practice, in resource-limited settings, in small point of care facilities and particularly in poorer countries. Quality and information provided by the procedure are increased avoiding whenever possible artefacts that can prevent or mislead the achievement of the correct diagnosis. Reliable monitoring of patients is possible, taking into consideration that appropriate expertise, knowledge, skills, training, and even adequate equipment’s suitability are not always and everywhere affordable or accessible. TUS is complementary imaging procedure for the radiologist and an excellent basic diagnostic tool suitable to be shared with pneumologists, cardiologists and emergency physicians.

• Thoracic ultrasound
• Pneumonia
• Pleural effusion
• Pneumothorax
• Clinical risk management
• Overdiagnosis
• Wastebasket diagnosis

Bedside ultrasonographic assessment of the lung and pleura provides rapid, noninvasive, and essential information in diagnosis and management of various pulmonary conditions. Ultrasonography helps in diagnosing common conditions, including consolidation, interstitial syndrome, pleural effusions and masses, pneumothorax, and diaphragmatic dysfunction. It provides procedural guidance for various pulmonary procedures, including thoracentesis, chest tube insertion, transthoracic aspiration, and biopsies. This article describes major applications of ultrasonography for the pulmonary consultant along with illustrative figures and videos.

• diaphragm dysfunction
• lung sliding
• lung ultrasonography
• pleural ultrasound
• thoracic ultrasound

• decision tree
• paracentesis
• pleural disease
• pleural effusion
• ultrasonography

• Fibrosis
• Humans
• Paracentesis/methods
• Pleura/diagnostic imaging
• Pleura/pathology
• Pleural Diseases/diagnostic imaging
• Pleural Effusion/diagnostic imaging
• Pneumothorax/diagnostic imaging
• Transducers
• Ultrasonography/instrumentation

• Humans
• Pleural Diseases/diagnostic imaging
• Pleural Neoplasms/diagnostic imaging
• Rib Fractures/diagnostic imaging
• Thoracic Diseases/diagnostic imaging
• Thoracic Neoplasms/diagnostic imaging
• Ultrasonography

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Drainage
• Female
• Follow-Up Studies
• Humans
• Lung Abscess/diagnostic imaging
• Lung Abscess/therapy
• Male
• Middle Aged
• Pleural Effusion/diagnostic imaging
• Pleural Effusion/therapy
• Pneumonia/diagnostic imaging
• Pneumonia/therapy
• Prospective Studies
• Punctures
• Radiography
• Ultrasonography, Interventional