SAEVA Congress 2018 Proceedings | 12-15 February 2018 | ATKV Goudini Spa
Sonographic air bronchogram
Sonographic fluid bronchograms are non-pulsatile , anechoic tubular structures that also converge towards the root of the lung , becoming larger as they converge . In contrast to air bronchograms , fluid bronchograms are only detectable sonographically , not radiographically . Although the diameter of sonographic fluid bronchograms normally decreases towards the superficial fluid alveologram , an increase in its diameter towards the periphery suggests pulmonary consolidation with fluid bronchiectasis . Sonographic fluid bronchograms can be differentiated from pulmonary vessels that are pulsatile , tubular structures that also enlarge as they converge towards the root of the lung . The consolidation is usually located cranioventrally with the right lung more frequently and more severely affected . Often , if the ultrasound examination is performed very early in the course of the disease and the pneumonia is severe , it will appear less extensive . These small sonolucent " tip of the iceberg " areas tend to coalesce into larger areas of consolidation as the disease process continues . A large area of consolidated lung is usually wedge-shaped , poorly defined , and sonolucent . Large areas of consolidation often appear heterogeneous ( anechoic , hypoechoic , and hyperechoic ) sonographically . The anechoic areas represent very fluid-filled or necrotic areas , hypoechoic areas are the typical consolidated areas containing fluid bronchograms , and hyperechoic areas represent air bronchograms . Hepatization of lung parenchyma occurs with severe consolidation , resulting in an ultrasonographic appearance similar to liver . Multiple small hyperechoic gas echoes in a severely consolidated or hepatized lung are suggestive of an anaerobic pneumonia . A rounded or bulging area of consolidation suggests severe consolidation , often progressing to pulmonary necrosis or abscess formation .
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