Lung ultrasound in nephrology: Basics, applications, limitations, and future directions

Figure 1 Lung ultrasound zones. A: Twenty-Eight-zone method: 16 intercostal spaces on the right and 12 on the left are examined; B: Eight-zone lung ultrasound: Four zones in left hemithorax. In this method, each zone may include more than one intercostal space.

Figure 2 Lung ultrasound images showing. A: Normal horizontal artifacts known as A-lines (indicated by arrows); B: Discrete B-lines (arrows); C: Confluent B-lines creating a white-out appearance in the scanned lung zone typically seen in alveolar edema. The arrowhead in each image indicates the pleural line.

Figure 3 Eight-zone B-line summaries obtained using a handheld ultrasound device (Philips Lumify^®) in a patient with end-stage kidney disease. A: Pulmonary edema following a missed hemodialysis session, with three or more B-lines counted by the machine in each lung zone; B: Marked improvement after 35 liters of ultrafiltration, now showing only one to two B-lines per zone, though there remains potential for further improvement with additional fluid removal.

Figure 4  Illustration demonstrating that B-lines are not specific to cardiogenic pulmonary edema.

Figure 5 Lung ultrasound images showing. A: Confluent B-lines with a thickened, irregular pleural line (arrow) in a patient with acute respiratory distress syndrome; B: A high-resolution image obtained using a linear transducer, highlighting subpleural consolidation (arrow).