Lung ultrasound: routine practice for the next generation of internists

Background: The lung is at the crossroads of ventilation and circulation and can provide a wealth of diagnostic information. In the past, lung ultrasound (LUS) was considered impossible. However, the interplay between air, fluid and pleurae creates distinctive artefacts. Combinations of these artefacts can help differentiate between various pathological processes, including pulmonary oedema, pneumonia, pulmonary embolism, obstructive airway disease and pneumothorax. LUS, when used by experienced physicians, is superior to chest X-ray and comparable to computed tomography for establishing a diagnosis in acutely dyspnoeic patients. LUS allows for rapid, non-invasive and bedside patient assessment. It is therefore unfortunate that unlike many other medical specialists in the Netherlands, internists have not yet incorporated LUS into their daily practice. Objectives: This review aims to be the starting point for internists wanting to acquire competence in LUS. Review content: This narrative review describes the principles of ultrasound equipment, LUS artefacts, gives practical guidance to perform LUS and provides a road map towards LUS competence. Furthermore, it presents a decision tree to differentiate between causes of acute dyspnoea. Authors conclusions: LUS is a promising diagnostic technique that can be of great help for the internist. It can be applied directly at the bedside and can also be used to follow up on disease progression and therapy. It is our belief that it will replace the stethoscope and that it will be the most used imaging technique in the near future, especially in dyspnoeic patients.