Tree-like colour Doppler in diagnosing pneumonia in critically ill: a picture is worth a thousand words

Excerpt

Pneumonia remains a difficult sonographic diagnosis in the critically ill. It is characterized by hypoechoic areas, irregular margins, heterogeneous echo texture, dynamic air bronchogram, pleural effusion and vascular flow within consolidated lung. Air bronchogram is an important sign in differentiating lung consolidation. When dynamic (strong echogenic structure with air moving through bronchi), linear or dendritic, it is a diagnostic sonographic sign of pneumonia (Fig. 1a, b). In contrast, the air bronchogram associated with obstructive atelectasis is static, determined by numerous scatter echogenic points created by entrapped air within the consolidated region (Fig. 1d). Since the estimation of lung vascular flow is not quantitative, intensivists, in general, are not familiar with colour‐flow Doppler findings. Pneumonia is strongly suggested when (1) the air bronchogram is visible till the peripheral bronchi (Fig. 1a, b) and (2) a tree-like distribution pattern of pulmonary vessels accompanies the bronchial tree (Fig. 1c).

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