Ultrasound Artifacts Research Articles

Impact of staged goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing McKeown esophagectomy: a randomized controlled trial

BackgroundOur aim was to evaluate the influence of staged goal directed therapy (GDT) on postoperative pulmonary complications (PPCs), intraoperative hemodynamics and oxygenation in patients undergoing Mckeown esophagectomy.MethodsPatients were randomly divided into three groups, staged GDT group (group A, n = 56): stroke volume variation (SVV) was set at 8–10% during the one lung ventilation (OLV) stage and 8–12% during the two lung ventilation (TLV) stage, GDT group (group B, n = 56): received GDT with a target SVV of 8–12% During the entire surgical procedure, and control group (group C, n = 56): conventional fluid therapy was administered by mean arterial pressure (MAP), central venous pressure (CVP), and urine volume. The primary outcome was the incidence of postoperative pulmonary complications within Postoperative days (POD) 7. The secondary outcomes were postoperative lung ultrasound (LUS) B-lines artefacts (BLA) scoring, incidence of other complications, the length of hospital stay, intraoperative hemodynamic and oxygenation indicators included mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), cardiac output (CO), oxygenation index (OI), respiratory indices (RI), alveolar-arterial oxygen difference (Aa-DO2).ResultsPatients in group A and group B had a lower incidence of PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p < 0.05), and a fewer B-lines score on postoperative ultrasound (4.61 ± 0.51 vs. 6.15 ± 0.74 and 4.75 ± 0.62 vs. 6.15 ± 0.74, p < 0.05) compared to group C. The CI, CO, MAP, and OI were higher in group A compared to group B and group C in the stage of thoracic operation. During the abdominal operation stage, patients in group A and group B had a better hemodynamic and oxygenation indicators than group C.ConclusionsIn comparison to conventional fluid therapy, intraoperative staged GDT can significantly reduce the incidence of postoperative pulmonary complications in patients undergoing McKeown esophagectomy, facilitating patient recovery. Compared to GDT, it can improve intraoperative oxygenation and stabilize intraoperative hemodynamics in patients.Trial registrationThis study was registered in the Chinese Clinical Trial Registry on 24/11/2021 (ChiCTR2100053598).

Precise liver tumor ablation: the clinical potential of US-US overlay fusion guidance.

Image-guided thermal ablation is a minimally invasive option for patients with early-stage hepatocellular carcinoma (HCC). However, the risk of local recurrence remains substantial because ultrasound (US) artifacts have a negative impact on the assessment of ablative margins during and immediately after ablation. Precise, real-time assessment of the ablation zone is key to reducing the risk of local tumor progression. With the advent of US image fusion technology, ablative margins can now be assessed three-dimensionally with greater accuracy. Therefore, US-US overlay fusion guidance has the potential to improve the local controllability of ablation in patients with HCC. This review discusses the US-US fusion guidance technique and its current clinical applications for hepatic interventions, with descriptions of its concept, methodology, and efficacy.

Comparison of human cadaver and blue phantom for teaching ultrasound-guided regional anesthesia to novice postgraduate students of anesthesiology: A randomized controlled trial.

Simulation is increasingly used in medical teaching. Various studies have evaluated different simulation models for training of regional anesthesia (RA). We compared the use of human cadaver and blue phantom models for training of regional anesthesia to novice postgraduate students of anesthesiology. Fifty students were taught knobology of the ultrasonography (USG) machine. They were divided into two equal groups by computer-generated random number table, and the groups assigned were kept in sealed envelopes. In group BP, students were trained on a blue phantom model, and in group HC, students were trained on human cadaver. After training, a didactic video of sonoanatomy of the supraclavicular block was shown to all participants. The block performance was then judged on patients requiring supraclavicular block. The primary objective of the study was to compare the block performance time, and secondary objectives were the quality of image acquired, orientation of transducer to the target, identification of ultrasound artifacts, errors committed, complications, and success rate. The mean block performance time was shorter in group HC compared to group BP (451.96 ± 50.25 and 526.48 ± 43.486 s, respectively; P < 0.001). The image quality score, transducer orientation to the target, and identification of USG artifacts were better in group HC compared to group BP, with lesser number of needle passes. Cadaver-based training produced better results compared to blue phantom simulator model for teaching of ultrasound-guided RA to novice postgraduate trainees of anesthesiology.

Ultrasound diagnosis and treatment of heterotopic ossification

Heterotopic ossification (HO), or the presence of bone in soft tissues, can occur after musculoskeletal trauma, causing pain and reduced mobility. However, even the most sensitive diagnostic modality requires 2–3 weeks after initiation to detect HO, and the only treatment is surgical resection after HO matures (&amp;gt;2 years). Here, we evaluate the color Doppler ultrasound twinkling artifact for early diagnosis of HO and focused ultrasound (fUS) for treatment of early HO. We began by evaluating twinkling and fUS parameters in ossified cell culture. We then evaluated imaging and treatment parameters in mice with HO. Results show that twinkling correlated well with the presence of ossified cells; although the exact size/number of ossified cells required for twinkling was unclear. In mice, twinkling was found to detect HO in some mice as early as 3 days-post-injection, which is earlier than other imaging modalities. For treatment, fUS at 1.07-MHz and 0.2% duty-cycle with p + /p− = 17/7 MPa was found to be most successful at disrupting mineralizations with little damage to surrounding cells. Mice treated with fUS were found to have less advanced HO compared to sham mice. These results highlight the promise of ultrasound for the diagnosis and treatment of early HO. [Work supported by CDMRP PR201164].

Total signal intensity of ultrasound laboratory vertical artifacts: A semi-quantitative tool

Quantitative approaches to improve lung ultrasound (LUS) vertical artifacts (VA) interpretation using total signal intensity (ITOT) are not widely available for clinical practice. In this study, we aimed to i) develop a mathematical algorithm to extract ITOT as a post-hoc LUS analysis and ii) confirm ITOT utility by conducting laboratory VA research using an in vitro model with different acoustic channels.The ITOT was extracted from static and conventional LUS imaging recorded from in vitro models after varying the amount of water content or the pores size of the phantom, compared to a control condition.The defined algorithm was able to calculate the ITOT from all phantoms. Mean ITOT showed statistically significantly different values across phantom categories.We demonstrate that ITOT may be able to differentiate the in vitro acoustic channels formed by increased water content from those with small size pores. However, the utility of this semi-quantitative tool in clinical practice or other LUS imaging data sets remains unclear.

Lung Ultrasound and Pleural Artifacts: A Pictorial Review.

Lung ultrasound is a well-established diagnostic approach used in detecting pathological changes near the pleura of the lung. At the acoustic boundary of the lung surface, it is necessary to differentiate between the primary visualization of pleural parenchymal pathologies and the appearance of secondary artifacts when sound waves enter the lung or are reflected at the visceral pleura. The aims of this pictorial essay are to demonstrate the sonographic patterns of various pleural interface artifacts and to illustrate the limitations and pitfalls of the use of ultrasound findings in diagnosing any underlying pathology.

Overview of artificial intelligence in point-of-care ultrasound. New horizons for respiratory system diagnoses.

Throughout the past decades ultrasonography did not prove to be a procedure of choice if regarded as part of the routine bedside examination. The reason was the assumption defining the lungs and the bone structures as impenetrable by ultrasound. Only during the recent several years has the approach to the use of such tool in clinical daily routines changed dramatically to offer so-called point-of-care ultrasonography (POCUS). Both vertical and horizontal artefacts became valuable sources of information about the patient's clinical condition, assisting therefore the medical practitioner in differential diagnosis and monitoring of the patient. What is important is that the information is delivered in real time, and the procedure itself is non-invasive. The next stage marking the progress made in this area of diagnostic imaging is the development of arti-ficial intelligence (AI) based on machine learning algorithms. This article is intended to present the available, innovative solutions of the ultrasound systems, including Smart B-line technology, to ensure automatic identification process, as well as interpretation of B-lines in the given lung area of the examined patient. The article sums up the state of the art in ultrasound artefacts and AI applied in POCUS.

A novel automated system to detect breast cancer from ultrasound images using deep fused features with super resolution

Cancer patients can benefit from early detection and diagnosis. This study proposes a machine vision strategy for detecting breast cancer in ultrasound images and correcting several ultrasound difficulties such artifacts, speckle noise, and blurring. In quantitative evolution, edge preservation criteria were discovered to be superior to standard ones for hybrid anisotropic diffusion. A learnable super-resolution (SR) is inserted in the deep CNN to dig for extra possible information. The feature is fused with a pre-trained deep CNN model utilizing Gabor Wavelet Transform (GWT) and Local Binary Pattern (LBP). Machine learning (ML) techniques that are used to create these recommendation systems require well-balanced data in terms of class distribution, however most datasets in the real world are imbalanced. Imbalanced data forces a classifier to concentrate on the majority class while ignoring other classes of interest, lowering the predicted performance of any classification model. We propose a generative adversarial networks (GAN) strategy to overcome the data imbalance problem and improve the performance of recommendation systems in this research. Standard data is used to train this model, which assures a high level of resolution. In the testing phase, generalized data of varied resolution is used to evaluate the model's performance. It is discovered through cross-validation that a 5-fold method can successfully eliminate the overfitting problem. With an accuracy of 99.48 %, this suggested feature fusion technique indicates satisfactory performance when compared to current related works. Finally finding cancer region, researcher used U-Net architecture and extract cancer region from BC ultrasound images.

Development of an Automated Ultrasound Signal Indicator of Lung Interstitial Syndrome.

The number and distribution of lung ultrasound (LUS) imaging artifacts termed B-lines correlate with the presence of acute lung disease such as infection, acute respiratory distress syndrome (ARDS), and pulmonary edema. Detection and interpretation of B-lines require dedicated training and is machine and operator-dependent. The goal of this study was to identify radio frequency (RF) signal features associated with B-lines in a cohort of patients with cardiogenic pulmonary edema. A quantitative signal indicator could then be used in a single-element, non-imaging, wearable, automated lung ultrasound sensor (LUSS) for continuous hands-free monitoring of lung fluid. In this prospective study a 10-zone LUS exam was performed in 16 participants, including 12 patients admitted with acute cardiogenic pulmonary edema (mean age 60 ± 12 years) and 4 healthy controls (mean age 44 ± 21). Overall,160 individual LUS video clips were recorded. The LUS exams were performed with a phased array probe driven by an open-platform ultrasound system with simultaneous RF signal collection. RF data were analyzed offline for candidate B-line indicators based on signal amplitude, temporal variability, and frequency spectrum; blinded independent review of LUS images for the presence or absence of B-lines served as ground truth. Predictive performance of the signal indicators was determined with receiving operator characteristic (ROC) analysis with k-fold cross-validation. Two RF signal features-temporal variability of signal amplitude at large depths and at the pleural line-were strongly associated with B-line presence. The sensitivity and specificity of a combinatorial indicator were 93.2 and 58.5%, respectively, with cross-validated area under the ROC curve (AUC) of 0.91 (95% CI = 0.80-0.94). A combinatorial signal indicator for use with single-element non-imaging LUSS was developed to facilitate continuous monitoring of lung fluid in patients with respiratory illness.

Evaluating Sonographers' Awareness of Artifacts in Renal Ultrasound Scans.

A routine ultrasound scan is used to assess a variety of renal pathological cases. Sonographers face a variety of challenges that may affect their interpretation. Understanding normal organ shapes, human anatomy, physical concepts, and artifacts is required for accurate diagnosis. Sonographers must understand how artifacts appear in ultrasound images in order to reduce errors and improve diagnosis. The purpose of this study is to assess sonographers' awareness and knowledge of artifacts in renal ultrasound scans. Participants in this cross-sectional study were asked to complete a survey containing different types of common artifacts in renal system ultrasound scans. An online questionnaire survey was used to collect the data. The questionnaire targeted radiologists, radiologic technologists, and intern students in Madinah hospitals in the ultrasound department. The total number of participants was 99, with 9.1% being radiologists, 31.3% being radiology technologists, 6.1% being senior specialists, and 53.5% being intern students. There was a significant difference in the participants' knowledge of ultrasound artifacts in the renal system with the total selection of the right artifact in senior specialists at 73% and intern students 45%. There was a direct relationship between age and years of experience in distinguishing artifacts in the renal system scan. A category of participants with the highest age and experience got 92% of the correct selection of artifacts. The study concluded that intern students and radiology technologists have limited knowledge of ultrasound scan artifacts, whereas senior specialists and radiologists have a high level of awareness of the artifacts.

Abstract 14117: Home Operated Ultrasound Exam for Detection of Worsening Heart Failure

Introduction: Acute Decompensated Heart Failure (ADHF) is associated with a high degree of morbidity and mortality. Dynamic lung ultrasound artifact called B-lines directly correlate with pulmonary vascular congestion (PVC) and can be seen on a limited lung ultrasound. Hypothesis: We assessed the ability of a recently hospitalized patient with ADHF to self-perform a lung ultrasound using a hand-held ultrasound and store images for physician interpretation. Methods: This was a prospective observational convenience sample of patients with known chronic heart failure admitted to an urban academic tertiary care center. The patient was educated on a 6 lung-zone image protocol, how to use the cloud archival system, and given a hand-held ultrasound transducer and iPad. The patients were asked to upload images three times a week, for 3 weeks. A B-line score for each interpretable lung zone was calculated. Results: Fifteen patients were enrolled, all of whom completed 7 or more scans. Average patient age was 60 years (range: 28- 86 years), 73% male, 60% white, and 47% obese. Five patients had ejection fraction &gt;50%, and average length of hospital stay was 6.3 days. Of the 792 potential images, 784 were obtained (99%) and 637 (81%) were interpretable. The right upper zone was most often interpretable (97%), whereas the left lateral zone was least (70%). Median patient B line score when indexed to 6 interpretable scans was 3.00. Indexed B line scores are shown for all 15 patients (Figure 1). Patient survey data identified the left lateral zone as the most challenging to obtain. Conclusions: This pilot study shows that patients with ADHF can be taught how to use a hand-held portable ultrasound device and obtain and upload lung ultrasound images to a cloud. Compliance with the study protocol was excellent. Further studies are needed to determine if patient-performed lung ultrasound can be useful to clinicians to detect and manage PVC in this patient population.

Kidney stone twinkling power in elevated oxygen, carbon dioxide, and nitrogen environments

Clinically, ∼66% of kidney stones exhibit the Doppler ultrasound twinkling artifact. Previous studies show breathing pure oxygen at elevated pressures increases twinkling compared to ambient air. Here, we investigate how different gases influence twinkling on ex vivo and in vivo human kidney stones. 38 kidney stones were imaged with a research ultrasound system and ATL L7-4 transducer in elevated oxygen, carbon dioxide, and nitrogen environments. In vivo stones were imaged with the same ultrasound system and ATL C5-2 transducer in 25 human subjects before and after breathing pure oxygen for 15 min. IQ data were processed by calculating the average Doppler power, or twinkling, for a region of interest containing the stone. In the lab, increasing oxygen by 55%, carbon dioxide by 100%, and nitrogen by 17% increased twinkling power an average of 70 ± 28%, 137 ± 53%, and 79 ± 31%, respectively. In human subjects, breathing oxygen increased twinkling power an average of 27 ± 58%, with seven subjects showing a strong increase (&amp;gt;30%); stone composition and patient age influenced twinkling in patients breathing oxygen. These results suggest that varying ambient gases may be leveraged to increase the consistency of twinkling and improve kidney stone detection with ultrasound. [Work supported by the PSU Center for Biodevices.]

Anisotropy and reproducibility of ultrasound shear wave elastography in patella tendons with and without tendinopathy

PurposeUltrasound shear wave elastography (SWE) is a tool that can be utilized to assess biomechanical properties of tendons. Anisotropy, an ultrasound imaging artifact has been commonly cited as a potential source of error in the accuracy and reproducibility of SWE. The aim of the study was to assess reproducibility in performing SWE of patella tendons and differences in SWE and anisotropy between normal patella tendons and patellar tendinopathy. MethodsAfter obtaining the Institutional Review Board approval and written informed consent, we prospectively measured the shear wave velocity (SWV) of patella tendons with and without tendinopathy in 25 volunteers. SWVs were measured in three anatomic planes: longitudinal, perpendicular transverse, and tilted transverse with the probe tilted 15–30° from the perpendicular transverse plane by three operators with varied levels of experience. Anisotropy coefficient (A) was calculated by formula of A = (SWVLongitudinal − SWVTransverse) / SWVTransverse. ResultsDifferences in SWV and anisotropy coefficient between normal tendons and tendons with tendinopathy were significant (p < 0.05). The intra- and inter-observer reproducibility in performing SWE were moderate to good (intraclass correlation coefficient: 0.81–0.95). The mean difference of 95% Bland-Altman limits of agreement for measuring tendon SWV ranged −0.08 to 0.41 (upper 0.08 to 1.14, lower −1.22 to −0.22) between senior and junior operators. ConclusionThe results of this study suggest that SWE and anisotropy coefficient are feasible tools to differentiate patellar tendinopathy from normal patella tendons. The reproducibility of performing SWE of patella tendons is moderate to good.

Lung Ultrasound Artifacts Interpreted as Pathology Footprints

The original observation that lung ultrasound provides information regarding the physical state of the organ, rather than the anatomical details related to the disease, has reinforced the idea that the observed acoustic signs represent artifacts. However, the definition of artifact does not appear adequate since pulmonary ultrasound signs have shown valuable diagnostic accuracy, which has been usefully exploited by physicians in numerous pathologies. A specific method has been used over the years to analyze lung ultrasound data and to convert artefactual information into anatomical information. A physical explanation of the genesis of the acoustic signs is provided, and the relationship between their visual characteristics and the surface histopathology of the lung is illustrated. Two important sources of potential signal alteration are also highlighted. The acoustic signs are generated by acoustic traps that progressively release previously trapped energy. Consequently, the acoustic signs highlight the presence of acoustic traps and quantitatively describe their distribution on the lung surface; they are not artifacts, but pathology footprints and anatomical information. Moreover, the impact of the dynamic focusing algorithms and the impact of different probes on the visual aspect of the acoustic signs should not be neglected.

The effect of gas composition on the color Doppler ultrasound twinkling artifact

The twinkling artifact, or twinkling, appears when imaging kidney stones and other mineralizations with Doppler ultrasound and is caused by scattering off crevice microbubbles. Previous work found that twinkling on in vivo kidney stones increased or decreased with elevated oxygen or carbon dioxide, respectively. However, it is unclear whether these results are from biological adaptions to the changing respiratory gas and thus if in vitro mineralizations are similarly affected. Here, cholesterol, calcium phosphate, and uric acid crystals were grown in vitro and imaged in deionized water using a Vantage-128 research ultrasound system with a Philips/ATL L7-4 transducer. Five of each crystal composition were imaged for one minute at different dissolved gas concentrations. By bubbling gas through water, dissolved oxygen ranged from 2 to 20 mg/L while dissolved carbon dioxide ranged from 30 to 290 mg/L. Twinkling on cholesterol crystals increased by 70% and 140% when oxygen and carbon dioxide levels were maximized, respectively. In contrast, twinkling on calcium phosphate and uric acid was not significantly affected by either gas. These results suggest that changes in twinkling from increased gas concentrations are dependent on crystal composition and are likely affected by biological adaptations in vivo. [Work supported by NSF-CAREER-1943937 and NSF-GRFP-DGE1255832.]

The effect of elevated oxygen on kidney stone twinkling in vivo and ex vivo

The Doppler ultrasound twinkling artifact is a rapid color shift observed in ∼66% of kidney stones. Breathing oxygen at elevated pressures was shown to enhance twinkling on kidney stones in human subjects. Here, in humans and in ex vivo stones, we investigate the effects of elevated oxygen at ambient pressure. Recruited subjects with confirmed stones were scanned with a research ultrasound system and Philips/ATL C5-2 transducer while breathing ambient air for 2 min. Then, subjects were masked with 100% oxygen for 15 min and scanned again for the last 2 min. Similarly, ex vivo stones were imaged before and after bubbling oxygen into water. Average Doppler power was calculated for in vivo and ex vivo stones. In human subjects, Doppler power increased by 30% when subjects breathed pure oxygen compared to ambient air. Similarly, on ex vivo stones, an average increase in Doppler power of 98% was observed in elevated oxygen conditions; twinkling also became visible on stones that otherwise did not twinkle at elevated oxygen (50% more oxygen than control). These results suggest that elevated oxygen at ambient pressure may improve the consistency of twinkling to detect kidney stones. [Work supported by the PSU Center for Biodevices Seed Grant.]

Boundary-oriented Network for Automatic Breast Tumor Segmentation in Ultrasound Images.

Breast cancer is considered as the most prevalent cancer. Using ultrasound images is a momentous clinical diagnosis method to locate breast tumors. However, accurate segmentation of breast tumors remains an open problem due to ultrasound artifacts, low contrast, and complicated tumor shapes in ultrasound images. To address this issue, we proposed a boundary-oriented network (BO-Net) for boosting breast tumor segmentation in ultrasound images. The BO-Net boosts tumor segmentation performance from two perspectives. Firstly, a boundary-oriented module (BOM) was designed to capture the weak boundaries of breast tumors by learning additional breast tumor boundary maps. Second, we focus on enhanced feature extraction, which takes advantage of the Atrous Spatial Pyramid Pooling (ASPP) module and Squeeze-and-Excitation (SE) block to obtain multi-scale and efficient feature information. We evaluate our network on two public datasets: Dataset B and BUSI. For the Dataset B, our network achieves 0.8685 in Dice, 0.7846 in Jaccard, 0.8604 in Precision, 0.9078 in Recall, and 0.9928 in Specificity. For the BUSI dataset, our network achieves 0.7954 in Dice, 0.7033 in Jaccard, 0.8275 in Precision, 0.8251 in Recall, and 0.9814 in Specificity. Experimental results show that BO-Net outperforms the state-of-the-art segmentation methods for breast tumor segmentation in ultrasound images. It demonstrates that focusing on boundary and feature enhancement creates more efficient and robust breast tumor segmentation.

Assessment of awareness of ultrasound artifacts among Saudi interns and radiologic technologists in Al Madinah hospitals

Assessment of awareness of ultrasound artifacts among Saudi interns and radiologic technologists in Al Madinah hospitals

The effect of crystal composition and environment on the color Doppler ultrasound twinkling artifact

Objective. Pathological mineralizations form throughout the body and can be difficult to detect using conventional imaging methods. Color Doppler ultrasound twinkling highlights ∼60% of kidney stones with a rapid color shift and is theorized to arise from crevice microbubbles as twinkling disappears on kidney stones at elevated pressures and scratched acrylic balls in ethanol. Twinkling also sometimes appears on other pathological mineralizations; however, it is unclear whether the etiology of twinkling is the same as for kidney stones. Approach. In this study, five cholesterol, calcium phosphate, and uric acid crystals were grown in vitro and imaged in Doppler mode with a research ultrasound system and L7-4 transducer in water. To evaluate the influence of pressure on twinkling, the same crystals were imaged in a high-pressure chamber. Then, the effect of surface tension on twinkling was evaluated by imaging crystals in different concentrations of surfactant (1%, 2%, 3%, 4%) and ethanol (10%, 30%, 50%, 70%), artificial urine, bovine blood, and a tissue-mimicking phantom. Main results. Results showed that all crystals twinkled in water, with cholesterol twinkling significantly more than calcium phosphate and uric acid. When the ambient pressure was increased, twinkling disappeared for all tested crystals when pressures reached 7 MPa (absolute) and reappeared when returned to ambient pressure (0.1 MPa). Similarly, twinkling across all crystals decreased with surface tension when imaged in the surfactant and ethanol (statistically significant when surface tension <22 mN m−1) and decreased in blood (surface tension = 52.7 mN m−1) but was unaffected by artificial urine (similar surface tension to water). In the tissue-mimicking phantom, twinkling increased for cholesterol and calcium phosphate crystals with no change observed in uric acid crystals. Significance. Overall, these results support the theory that bubbles are present on crystals and cause twinkling, which could be leveraged to improve twinkling for the detection of other pathological mineralizations.

Pulmonary Sonography - Neonatal Diagnosis Part 2.

A healthy, air-filled lung can only be visualized by its artifacts, and pathologies of the lung are revealed by changes in these artifacts. Because ultrasound artifacts are predominantly used in pulmonary sonography to assess pathologic processes, the variability of sonographically imageable phenomena is limited. For this reason, different pulmonary diseases may present very similarly in ultrasound. Therefore, a correct interpretation of the findings is only possible in the clinical context, taking into account the age-dependent differential diagnoses.The particular relevance of lung ultrasound in the treatment of neonatal patients results from a close correlation between the extent of sonographically-depictable pathologies and parameters of respiratory insufficiency. This suggests a direct correlation between ultrasound findings and the severity of lung injury. Lung ultrasound thus represents a unique, ubiquitously available, bedside, serial method for monitoring the pulmonary status.