[Thoraxsonography--Part 1: Chest wall and pleura].

The detection of lymph nodes and a careful interpretation of dignity is one of the main indications for chest wall sonography. Palpable unclear masses of the chest wall can undergo US guided puctures very easily. Either rib and sternum fractures are detectable very sensitively. In addition to the more sensitive detection than in normal X-ray also accompanying soft parts processes, pleural effusions and haematomas can be visualised. Despite the physical laws of ultrasound, approximately 70% of the pleural surface can be accessed by sonography. The normal parietal pleural can be visualized and delineated from circumscribed as well as diffuse pathological thickening. The normal visceral pleura is hidden by the total reflection at the surface of the aerated lung. Sonographic evidence of a pleural effusion can be obtained from 5 ml onwards and is much more sensitive than a chest X-ray, especially in supine position; false positive findings are not encountered. A more accurate estimation of the quantity of effusion can be made. Exudates are echogenic in one third of cases. Pleural thickening, nodular changes in the pleura, septa, and the formation of the quality of effusion can be made. Exual exudates, whereas transudates are always anechoic. Pleural metastases are characteristically hypoechoic and nodular-polypoid. Pleural mesotheliomas can be delineated nearly equally well on sonograms and on computed tomography. Morphological and, in particular, functional diagnosis of the diaphragm by means of sonography is both reliable and convincing.