Correct!
3. Consolidation due to pneumonia
The ultrasound of the right chest reveals a large consolidation of the right lower lobe. The patient was in septic shock due to bacterial pneumonia. The sputum cultures grew Staphylococcus aureus and Klebsiella pneumoniae. The ultrasound of the thorax presented is remarkable for the demonstration of a large consolidation with air moving within the bronchi. This is visualized as hyperechoic moving “bubbles” that represent air bubbles moving in and out of consolidated lung within the bronchial tree. Presumably the bronchi are also partly filled with fluid. The moving air within the bronchi is termed by Lichenstein as a “dynamic air bronchogram" (1).
Figure 1. Static image of Video 2 demonstrating areas where dynamic air bronchograms are seen (Arrows). Also marked is the consolidation (C), pleural effusion (P), and liver (L). Video 2 from previous page is at the right for comparison.
Figure 2. Coronal computerized tomogram of the abdomen in the same patient demonstrating the lung consolidation with air bronchogram.
This case illustrates that ultrasonography is advantaged by the ability to image dynamic findings, and this is relevant for lung ultrasound. The clinical significance of a dynamic air bronchogram was originally described by Lichtenstein et al. (1) who demonstrated it had a high sensitivity and specificity for lung consolidation and pneumonia. In the author’s smaller series of consecutive lung ultrasounds, dynamic air bronchograms, while rare, were always associated with bacterial (lobar) pneumonia (2). This case was no exception.
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