In many cases of pulmonary diseases extending up to the pleura, ultrasound
helps to identify the etiology of the lesion. There are several sonomorphol
ogical criteria to differentiate peripheral pulmonary consolidations. Clini
cal studies and the sonographic appearance with pathologic correlation show
ed pulmonary infarctions in location, form and size exactly corresponding w
ith pathological findings. Fresh reperfusable infarcts were homogenous and
hypoechoic. Older infarcts were well demarcated, mainly wedge shaped. Trian
gular pleural based lesions, more roughly structured, were observed with a
hyperechoic reflex in the center corresponding to the bronchiole: a sign of
segmental involvement. The sensitivity of transthoracic ultrasound in diag
nosis of pulmonary embolism was 86 to 94 %, the specificity 67 to 87 %, pos
itive predictive value 55 to 92 %, negative predictive value 91 %, accuracy
73 to 91 %. In massive central lung embolism, both fresh and old infarctio
ns are found. An imminent larger embolism can be predicted, for instance, i
n a deep vein thrombosis. With one ultrasound system, we can "kill three bi
rds with one stone": source, way and outcome of pulmonary embolism by bedsi
de examination.