Introduction: Budd-Chiari syndrome (BCS) is a rare liver disease defined as an obstruction of the hepatic venous outflow, potentially leading to severe complications like liver failure. BCS can be classified as primary (due to endoluminal venous lesions such as thrombosis) or secondary (due to external compression or invasion of the hepatic veins or inferior vena cava; IVC). While numerous case reports illustrate imaging findings in individual patients, systematic data processing across multiple regions is lacking and establishing consistent ultrasound diagnostic criteria could significantly improve early detection and patient outcomes. METHODS:This retrospective multicenter study (2010-2020) included 118 patients from China (n = 59), Germany (n = 26), India (n = 18), and Italy (n = 15). The study used standardized ultrasound protocols, including Doppler and contrast-enhanced ultrasound, to assess hepatic venous outflow and other key findings, such as the presence of hepatic-vein thrombosis, caudate lobe hypertrophy, and collateral circulation. RESULTS:The cohort comprised 118 patients (65 men, 53 women; mean age 46 years). Most cases had a chronic disease course (74%), and primary BCS (n = 96, 81%), related to thrombotic alterations, predominated over secondary BCS, related to compressive masses (n = 7, 6%). Key sonographic features observed included portal vein thrombosis (14%), hepatic-vein thrombosis (70%), caudate lobe enlargement (30%), and collateral venous circulation (83%). Among the geographical differences in symptoms, thrombosis of the IVC was common in Chinese patients (33%), while the confluence area and hepatic veins were more frequently involved in European patients. CONCLUSIONS:This study provides the first multicenter analysis of ultrasound characteristics in BCS patients from multiple regions. The findings support ultrasound as an essential tool in the standardized diagnostic process for BCS, particularly for identifying key sonographic features such as hepatic-vein thrombosis and caudate lobe enlargement. These results underscore the importance of standardized ultrasound protocols in BCS to facilitate early diagnosis and improve patient outcomes. .

Transthoracic ultrasound (TUS) is an established imaging modality for the diagnosis and bedside monitoring of pleural effusions, pneumothorax, inflammatory pleural disease, thoracic wall lesions, peripheral pulmonary consolidations, and interstitial lung diseases. Contrast-enhanced ultrasound (CEUS) further improves lesion characterization by differentiating viable inflammatory tissue from necrosis and abscess formation. While the sonographic appearance of common thoracic diseases is well described, ultrasound findings in rare pulmonary and pleural conditions remain insufficiently documented. This review presents the characteristic transthoracic ultrasound (TUS) findings in several uncommon thoracic disorders, including abscessing fire-eater's pneumonia after paraffin aspiration, tracheal hemangioma, thoracic wall hemangioma, biliopleural fistula following percutaneous transhepatic cholangiodrainage (PTCD), bronchial rupture with hemopneumothorax, spontaneous pneumomediastinum, esophagopleural fistula, diaphragmatic cyst, and post-traumatic diaphragmatic paralysis. The sonographic findings are correlated with the clinical presentation and complementary imaging modalities.

ObjectivesLung ultrasound (LUS) has evolved into a widely used tool for the assessment of pleural artifacts (PA), yet the field remains trapped in a terminology Tower of Babel. A proliferation of terms has fragmented the literature, obstructed communication, and hindered progress toward standardization.Materials and methodsBetween January and February 2025, a structured but unsystematic literature review was conducted via Google Scholar to identify terminology used for PA. Twelve distinct terms were identified: A-lines, B-lines, comet-tail artifact, vertical artifact, horizontal artifact, reverberation artifact, mirror-image artifact, ring-down artifact, interstitial syndrome, wet lung, dry lung, and aurora sign. Relevant publications were selected based on predefined keyword combinations and expert review. An analysis of terminology usage was performed for 2000-2025.ResultsThe analysis revealed an increase in PA mentions from 751 (2000-2004) to 16,269 (2020-2025), representing more than a twenty-fold increase (+2,066%). Eleven of the twelve PAs showed significant annual growth; only the aurora sign did not demonstrate a consistent increase in usage over time.ConclusionThe simultaneous increase in nearly all terms for the same physical phenomena reflects a persistent lack of consensus in the literature. While other imaging fields, such as computed tomography, have adopted standardized glossaries like that of the Fleischner Society, LUS remains without a unified terminology. A shared, technology-independent vocabulary is needed to ensure clarity, comparability, and future progress in LUS.Critical relevance statementA shared, technology-independent vocabulary is needed to ensure clarity, comparability, and future progress in lung ultrasound (LUS).Key PointsStandardized studies and methodological progress require a unified nomenclature.The ultrasound community currently lacks consistent terminology for pleural artifacts (PA).A consensus, unified terminology for PA is urgently needed.

Background/Objectives: Pleura-based pulmonary nodules in soft-tissue sarcoma (STS) patients remain diagnostically challenging, and entity-specific contrast-enhanced ultrasound (CEUS) data are scarce. We aimed to characterize CEUS perfusion patterns of pleura-based STS pulmonary metastases in a pilot cohort. Methods: We investigated a single-center retrospective cohort at a tertiary STS referral center (Dec 2024–Dec 2025). Of 51 consecutive STS patients with suspected pulmonary metastases screened, 32 lacked pleural contact and 6 were excluded for logistical reasons; the remaining 13 underwent standardized CEUS of a pleura-contacting lesion (≥5 mm) visible on B-mode lung ultrasound (B-LUS), with 1 excluded on biopsy (anaplastic lymphoma). The reference standard combined histology, therapy-related size reduction of the index lesion, and/or documented distant metastatic STS. Two readers rated all examinations independently, with adjudication by a third senior reader. Wilson 95% confidence intervals (CIs) and Cohen’s κ were computed. Results: In the 12 analyzed patients (mean age 58.8 ± 17.8 years; 7 male), the index lesion was histologically confirmed in 4 (33.3%). On CEUS, bronchial-arterial (BA) enhancement predominated (10/12; 83.3%, 95% CI 55.2–95.3%) and pulmonary-arterial timing occurred in 2/12 (16.7%). Marked enhancement was present in 9/12 (75.0%), homogeneous in 8/12 (66.7%), and rapid washout (<120 s) in all lesions (12/12; 100%, 95% CI 75.8–100%). Inter-reader agreement was substantial to almost perfect for the diagnostically relevant CEUS perfusion variables (enhancement κ = 0.75; EE κ = 0.80; HE κ = 0.82) and moderate for the descriptive shape variable (Form κ = 0.47). Conclusions: In this selected pilot cohort, pleura-based STS lung metastases most commonly showed BA-dominant enhancement with universal rapid washout. The findings are hypothesis-generating and require validation in larger, prospective multicenter cohorts.

Necrotizing (abscessing) lymphadenopathy is a clinically relevant condition with a broad differential diagnosis, including acute bacterial infections, mycobacterial disease, zoonoses, fungal and parasitic infections, autoimmune disorders, and malignancies with central necrosis. Early and reliable differentiation between these causes is important to avoid misdiagnosis and to guide appropriate therapy. This review summarizes the pathophysiological mechanisms, typical imaging features, and diagnostic value of contrast-enhanced ultrasound (CEUS) in necrotizing lymphadenopathy. Representative clinical vignettes illustrate the disease spectrum and correlate CEUS patterns with underlying pathology. The literature review was narrative and based on targeted searches of PubMed/MEDLINE and Google Scholar focusing on CEUS in necrotizing lymphadenopathy. A brief literature overview highlights current evidence, limitations, and research gaps. Conventional B-mode ultrasound (BMUS) and Doppler typically demonstrate enlarged hypoechoic or heterogeneous nodes with reduced central vascularity but lack specificity for necrosis. CEUS provides real-time visualization of nodal microvascular perfusion, which may support clearer differentiation between viable tissue and necrotic or abscess cavities. Common but non-specific CEUS patterns include central non-enhancement with a peripheral hyperemic rim in abscesses, irregular avascular cores in tuberculous lymphadenopathy, patchy non-enhancing areas in autoimmune conditions, and heterogeneous enhancement with ill-defined necrosis in malignant nodes. CEUS can support biopsy targeting, facilitate drainage procedures, and enable radiation-free follow-up. CEUS may offer diagnostic and interventional advantages in the evaluation of necrotizing lymphadenopathy, offering more consistent characterization of nodal necrosis compared with conventional sonography. While most evidence focuses on tuberculosis and malignancy, growing experience with zoonotic and autoimmune diseases suggests broader utility. Most currently available evidence derives from observational studies and small case series, highlighting the need for prospective multicenter validation. Standardization of CEUS criteria, integration into multiparametric ultrasound protocols, and multicenter validation are needed to establish CEUS as a routine component in the diagnostic work-up of necrotizing lymphadenopathy.

Background: Pleural effusion (PE) is a frequent complication in patients with malignancies and is often associated with poor prognosis. Lung ultrasound (LUS) has become an indispensable bedside tool for detecting, characterizing, and guiding the management of pleural effusions. Methods: This narrative review summarizes the current evidence on the diagnostic performance of LUS for PE in cancer patients, emphasizing recent advances in functional ultrasound techniques. Results: B-mode LUS can detect small-volume effusions and estimate their volume. Sonographic features such as echogenicity, septations, and pleural abnormalities can help differentiate transudative from exudative effusions. Shear-wave elastography and contrast-enhanced ultrasound provide additional functional information on tissue stiffness and perfusion. This information may help distinguish between malignant and benign pleural lesions and facilitate targeted biopsy when cytology is nondiagnostic. Compared with computed tomography, LUS offers superior evaluation of juxtadiaphragmatic and pleural surface abnormalities. It facilitates safe, real-time thoracocentesis. Recent innovations, including improved quality, affordable handheld ultrasound systems and artificial intelligence-based analysis, are expected to further enhance diagnostic precision and accessibility. Conclusions: Although LUS is a sensitive and versatile tool for assessing PE in cancer patients, it has limited diagnostic accuracy in distinguishing between benign and malignant effusions. Advanced techniques, such as shear-wave elastography and contrast-enhanced ultrasound, may further support the differentiation of malignant and benign diseases. Ongoing technological advances are likely to enhance the diagnostic accuracy and accessibility of lung ultrasound.

In all imaging methods, including contrast-enhanced ultrasound (CEUS), enhancement in the late phase (LP) is an important criterion for differentiating between benign and malignant focal liver lesions (FLLs). In general, malignant liver lesions are characterized by hypoenhancement and washout in the LP. A lesion with LP hyperenhancement or isoenhancement in the non-cirrhotic liver is usually benign. However, LP hypoenhancement in benign lesions is not so rare, and is even normal and the standard for some lesions, and there are exceptions for each tumor entity that can represent a diagnostic challenge. Knowing these contrast patterns and exceptions is key for correct diagnosis and patient management. The following narrative review describes the contrast behaviors and the frequency of washout and LP hypoenhancement for common as well as rare benign liver lesions and analyzes its causes.

Aim:In patients with multiple myeloma, extramedullary myeloma manifestations can occur alongside bone marrow infiltration and osseous involvement. The aim of this study was to describe extramedullary myeloma manifestations using B-mode ultrasound and contrast-enhanced ultrasound. Material and methods:Between February 2006 and 2021, a total of 21 patients with multiple myeloma and histologically or clinically proven extramedullary myeloma manifestations (n = 24) were included. All patients underwent B-mode ultrasound and contrast-enhanced ultrasound of extramedullary myeloma manifestations. B-mode ultrasound patterns of location, size border characteristics, and echogenicity (hypoechoic/isoechoic or hyperechoic) as well as contrast-enhanced ultrasound enhancement (hyper-, iso-, or hypoenhancement) were analyzed. Results:In most cases, extramedullary myeloma manifestations were located in the chest wall (n = 11; 45.8%). In all 24 cases, extramedullary myeloma manifestations were hypoechoic on B-mode ultrasound. N = 16 (66.6%) of extramedullary myeloma manifestations had smooth and n = 8 (33.3%) had irregular borders. The mean lesion size was 5.4 cm. On contrast-enhanced ultrasound, extramedullary myeloma manifestations presented arterial hyper- (n = 20; 83.3%) or isoenhancement (n = 4; 16.7%) followed by parenchymal iso- (n = 1; 4.2%) or hypoenhancement (n = 23; 95.8%). In molecular genetic analysis, every patient with reliable FISH results tested positive for at least one aberration considered "high-risk". Conclusion:Extramedullary myeloma manifestations were typically hypoechoic on B-mode ultrasound. On contrast-enhanced ultrasound, they presented characteristic arterial hyperenhancement followed by parenchymal washout. All patients studied for the genetic risk status were found to be "high-risk".

BACKGROUND:Point-of-care ultrasound (POCUS) is a versatile and cost-effective technology that can significantly enhance medical education and clinical practice. This study examines the acceptance of POCUS among medical students and explores strategies to optimize its integration into their training. MATERIALS AND METHODS:A total of 318 medical students, spanning both preclinical and clinical semesters, participated in seminars that included POCUS demonstrations and hands-on practice. Their perceptions were assessed through a voluntary questionnaire based on the Technology Acceptance Model (TAM), which furthermore explored the ideal timing and potentially suitable subjects for integrating POCUS into the curriculum, with an emphasis on its role in developing clinical skills and supporting decision-making. RESULTS:Among preclinical students, 60.7% had no prior ultrasound exposure, while 97% of clinical students reported some experience, albeit often limited. Despite the majority of senior students having some ultrasound experience, many lacked confidence in its use. Confidence in sonography skills was generally low across both groups, with 95.9% of preclinical and 79.4% of clinical students expressing a lack of confidence. Importantly, both preclinical and clinical students recognized the high usefulness of POCUS skills and rated the technology as user-friendly, with clinical students perceiving it as slightly easier to use. When asked to identify the most suitable subjects for POCUS training, students most frequently cited anatomy (35.2%) and internal medicine (16.7%). Additionally, a majority of students (57.7%) advocated for POCUS education to begin as early as the first semester. CONCLUSION:This study highlights a significant gap in ultrasound training among medical students, while also underscoring their strong motivation to learn and their positive perception of POCUS as a valuable tool for enhancing clinical skills and decision-making. The findings emphasize that early integration of sonography into the medical curriculum is both highly desired by students and essential for advancing medical education. This is particularly timely and important given the growing role of artificial intelligence in ultrasound technology and the opportunities expected to emerge from this integration.

Contrast-enhanced ultrasound (CEUS) is a reliable examination procedure to differentiate benign and malignant liver lesions, which is superior to contrast enhanced computed tomography (CECT) and equally to contrast enhanced magnetic resonance imaging (CEMRI) in large comparative studies. In this review, the data on the enhancement of malignant liver lesions in the late phase in CEUS are analyzed in detail. Hypoenhancement in the late phase on CEUS with SonoVue® is a typical feature of metastases and other malignant tumors. However, this is not guaranteed in every case. It is explicitly analyzed in the present studies which malignant lesions did not demonstrate washout in the late phase with SonoVue®. Lack of washout is known for some hepatocellular carcinomas. However, there are also a few rare exceptions described for metastases of neuroendocrine tumors. The possible causes are analyzed. While metastases and cholangiocellular carcinoma demonstrate an early marked washout, this can start very late in neuroendocrine metastases. Some predominantly well differentiated hepatocellular carcinomas in the cirrhotic liver may also show no or only very delayed and faintly washout in the late phase. Isoenhancement at the beginning of the late phase does not rule out metastases or HCC (in the cirrhotic liver). This contrast behavior is known for some HCC in the cirrhotic liver, but it is atypical, poorly reported and understood, especially in liver metastases. The present review analyzes the data on isoenhancement in the late phase of malignant liver lesions. The novel aspect is the focus on liver metastases.

Purpose To describe the perfusion patterns of solitary fibrous tumors of the pleura (SFTP) using contrast-enhanced ultrasound (CEUS).Materials and Methods Between November 2012 and 2024, six patients with histologically confirmed SFTP underwent B-mode ultrasound (B-US) and CEUS. Parameters from the arterial phase, including flow-in pattern, extent of enhancement (EE; marked or reduced/absent), and homogeneity of enhancement (HE; homogeneous or inhomogeneous) were retrospectively analyzed.Results All 6 lesions displayed a flow-in perfusion pattern that originated from a peripheral point. Five lesions (83.3%) exhibited arterial hyperenhancement and 1 (16.7%) showed hypoenhancement. HE was inhomogeneous in 5 lesions (83.3%) and homogeneous in 1 (16.7%).Conclusion On CEUS, all cases showed an arterial flow-in perfusion that originated from a peripheral point in an SFT, which could be a diagnostic clue for the non-invasive diagnosis of SFTPs. Given the risk of tumor seeding, direct surgical resection may be preferable to biopsy in these cases.

Lung cancer is one of the most commonly diagnosed malignancies worldwide and continues to be a leading cause of cancer-related mortality. Precise staging is crucial for predicting outcomes and directing treatment decisions. Current international guidelines mainly recommend imaging techniques like CT and PET-CT, with limited references to transcutaneous ultrasound, which is only suggested in particular clinical cases. Ultrasound provides real-time imaging, high resolution in near-field structures, and the ability to assess thoracic wall infiltration, supraclavicular and cervical lymph nodes, pleural effusions, and metastatic lesions. Furthermore, ultrasound-guided biopsies can enable quick and safe histological confirmation of accessible lesions. Based on these advantages and a review of current literature, we propose that integrating ultrasound into staging algorithms could improve diagnostic efficiency, decrease invasive procedures, and support prompt treatment planning. We also highlight the need for further research in this area.

The manifestation of benign hematological infiltration in the liver is a challenge due to their rare occurrence and therefore, limited awareness and the general need for biopsy and histological confirmation. Owing to the rarity of these lesions, there are limited data concerning their appearance on ultrasound and, specifically, contrast-enhanced ultrasound. In a series of papers, we have compiled the US and CEUS characteristics of rare FLL, where there are few reports and images available, in order to build up a library of these cases. This paper describes the US and CEUS features of benign hematological FLL which include hepatic extramedullary hematopoiesis (EMH), hemophagocytic lymphohistiocytosis (HLH) and reactive lymphoid hyperplasia (RLH). Although these lesions occur rarely in the liver, their correct identification is imperative for appropriate patient`s management.

To describe and categorize splenic cystic-appearing lesions (S-CAL) with B-mode and contrast-enhanced ultrasound (CEUS). This retrospective study investigated S-CALs in 111 patients between 2003 and 2023 in an interdisciplinary ultrasound center with B-mode ultrasound, color Doppler sonography (CDS), and CEUS. S-CAL was characterized by echogenicity, diameter, and shape, as well as additional features like septation, calcification, or wall thickening, and CDS/CEUS were used to identify perfusion. Histological examination or imaging follow-up was necessary to determine the nature of S-CAL. Moreover, ‘S-CAL with risk’ was defined, necessitating further procedures. Four types (0–III) of S-CALs were defined based on ultrasound parameters. Fisher’s exact test was used to compare non-parametric data. S-CAL of 111 patients (58 female, 53 men—average age: 58.6 years) was examined. Final diagnoses were: splenic cyst (n = 64, 57.7

Primary pulmonary sarcoma and mesothelioma are rare malignancies. The review article discusses the appearance of these tumors in B-mode ultrasound (US), color Doppler ultrasound and contrast-enhanced ultrasound (CEUS). In particular, the article is intended to inspire the examination of thoracic wall tumors and pleural masses with the possibilities of ultrasonography and to obtain histologically evaluable material using US or CEUS-guided sampling.

The diagnosis or rare, non-hematologic malignant lesions of the liver may be a challenge owing to the rarity of the disease, and is usually made by histological confirmation. Ultrasound with color Doppler and contrast-enhanced, if required, taking into account the clinical background of the patient, may help to focus the differential diagnosis. In this review, we describe the pathological and ultrasound features of rare malignant neuroendocrine and predominantly epithelioid liver lesions including primary neuroendocrine tumor of the liver, Invasive mucinous cystic neoplasm of the liver, and also hepatoblastoma.

Lung ultrasound is a well-established diagnostic approach used in detecting pathological changes near the pleura of the lung. At the acoustic boundary of the lung surface, it is necessary to differentiate between the primary visualization of pleural parenchymal pathologies and the appearance of secondary artifacts when sound waves enter the lung or are reflected at the visceral pleura. The aims of this pictorial essay are to demonstrate the sonographic patterns of various pleural interface artifacts and to illustrate the limitations and pitfalls of the use of ultrasound findings in diagnosing any underlying pathology.