Lung and ultrasound: time to "reflect".

BACKGROUND: Literature concerning lung ultrasonography is largely growing and opening new diagnostic opportunities. The clinical value of the ultrasonographic interstitio-alveolar syndrome, based on artifactual (lung comets or B-lines) rather than real images, in the detection of lung contusion, pneumonia and pulmonary edema, is clearly demonstrated. As clinical echographists, though, we are living the paradox of relying our experience in lung pathology on images whose biophysical and genetic nature is not fully understood. OBJECTIVE AND PERSPECTIVES: A detailed review of the ultimate findings with an analysis of recent and past literature regarding the formation of ultrasonographic artifacts was undertaken with the aim of clarifying what we know and where we are heading in this field. It is important for us to underline how lung ultrasonography is not morphological, as this, along with the study of artifact formation, will be the base for the development of a novel 'view' able to take us from artifact to reality in terms of 'quantification' of lung disease and damage.
CONCLUSIONS: Lung ultrasonographic artifacts need to be read in a new light which will privilege biophysical knowledge and research. In this field a gap of basic knowledge clearly exists. A greater understanding of the formation of acoustic artifacts from ultrasound interference on discretely aerated tissues of variable density, would place the practice of lung "ultrasonography" in the correct technological and clinical position.