Skip to main content
Log in

Ultrasound diagnosis of alveolar consolidation in the critically ill

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript



Alveolar consolidation is a basic concern in critically ill patients. Radiography is not a precise tool, and referral to CT raises problems (transport, irradiation). The aim of this study was to assess the utility of ultrasound in the diagnosis of alveolar consolidation.


Prospective clinical study.


The medical ICU of a university-affiliated teaching hospital.


A total of 65 cases of alveolar consolidation proven on CT were compared to 53 CT controls.


Alveolar consolidation was defined as a tissue-like pattern visible at the chest wall, arising from the pleural line and devoid of centrifugal inspiratory dynamics.


Feasibility was 99%. In 65 cases of alveolar consolidation, ultrasound was positive in 59 and negative in 6. In 52 analyzable controls, ultrasound was negative in 51 and positive in 1. Sensitivity of ultrasound was 90% and specificity 98%. A concordance test showed a Kappa coefficient of 0.89. Among 62 posterior locations on CT, ultrasound showed posterior consolidation patterns in 56 cases and was negative in 6. Ultrasound showed anterior involvement in all 3 cases of whole lung consolidation.


Ultrasound provides a reliable non-invasive, bedside method for accurate detection and location of alveolar consolidation in critically ill patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3a
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others


  1. Greenbaum DM, Marschall KE (1982) The value of routine daily chest X-rays in intubated patients in the medical intensive care unit. Crit Care Med 10:29–30

    Article  CAS  Google Scholar 

  2. Henschke CI, Pasternack GS, Schroeder S, Hart KK, Herman PG (1983) Bedside chest radiography: diagnostic efficacy. Radiology 149:23–26

    Article  CAS  Google Scholar 

  3. Janower ML, Jennas-Nocera Z, Mukai J (1984) Utility and efficacy of portable chest radiographs. AJR Am J Roentgenol 142:265–267

    Article  CAS  Google Scholar 

  4. Wiener MD, Garay SM, Leitman BS, Wiener DN, Ravin CE (1991) Imaging of the intensive care unit patient. Clin Chest Med 12:169–198

    CAS  PubMed  Google Scholar 

  5. Lefcoe MS, Fox GA, Leasa DJ, Sparrow RK, McCormack DG (1994) Accuracy of portable chest radiography in the critical care setting. Chest 105:885–887

    Article  CAS  Google Scholar 

  6. Peruzzi W, Garner W, Bools J, Rasanen J, Mueller CF, Reilley T (1998). Portable chest roentgenography and CT in critically ill patients. Chest 93:722–726

    Article  Google Scholar 

  7. Wyncoll DL, Evans TW (1999) Acute respiratory distress syndrome. Lancet 354:497–501

    Article  CAS  Google Scholar 

  8. Weinberger SE, Drazen JM (2001) Disturbances of respiratory function. In Braunwald E, Fauci AS, Kaspar DL, Hauser SL,Longo DL (eds) Harrison’s principles of internal medicine, 15th edn. McGraw-Hill, New York p 1454

  9. Lichtenstein D (2001) Lung ultrasound in the intensive care unit. Recent Res Dev Resp Crit Care Med 1:83–93

    Google Scholar 

  10. Weinberg B, Diakoumakis EE, Kass EG, Seife B, Zvi ZB (1986) The air bronchogram: sonographic demonstration. AJR Am J Roentgenol 147:593–595

    Article  CAS  Google Scholar 

  11. Dorne HL (1986) Differentiation of pulmonary parenchymal consolidation from pleural disease using the sonographic fluid bronchogram. Radiology 158:41–42

    Article  CAS  Google Scholar 

  12. Yang PC, Luh KT, Chang DB, Yu CJ, Kuo SH, Wu HD (1992) Ultrasonographic evaluation of pulmonary consolidation. Am Rev Respir Dis 146:757–762

    Article  CAS  Google Scholar 

  13. Targhetta R, Chavagneux R, Bourgeois JM, Dauzat M, Balmes P, Pourcelot L (1992) Sonographic approach to diagnosing pulmonary consolidation. J Ultrasound Med 11:667–672

    Article  CAS  Google Scholar 

  14. Lichtenstein D, Menu Y (1995) A bedside ultrasound sign ruling out pneumothorax in the critically ill: lung sliding. Chest 108:1345–1348

    Article  CAS  Google Scholar 

  15. Lichtenstein D, Hulot JS, Rabiller A, Tostivint I, Mezière G (1999). Feasibility and safety of ultrasound-aided thoracentesis in mechanically ventilated patients. Intensive Care Med 25:955–958

    Article  CAS  Google Scholar 

  16. Lichtenstein D, Mezière G, Seitz J (2002) Le “bronchogramme aérien dynamique”, un signe échographique de consolidation alvéolaire non rétractile. Reanimation 11 [Suppl 3]:98s

  17. Mathis G, Bitschnau R, Gehmacher O, Scheier M, Kopf A, Schwarzler B, Amann T, Doringer W, Hergan K (1999) Chest ultrasound in diagnosis of pulmonary embolism in comparison to helical CT. Ultraschall Med 20:54–59

    Article  CAS  Google Scholar 

  18. Reissig A, Heynes JP, Kroegel C (2001) Sonography of lung and pleura in pulmonary embolism: sonomorphologic characterization and comparison with spiral CT scanning. Chest 120:1977–1983

    Article  CAS  Google Scholar 

  19. Yang PC, Luh KT, Lee YC et al. (1991) Lung abscesses: ultrasound examination and ultrasound-guided transthoracic aspiration. Radiology 180:171–175

    Article  CAS  Google Scholar 

  20. Torres A, Jimenez P, Puig de la Bellacasa JP, Celis R, Gonzales J, Gea J (1990) Diagnostic value of nonfluoroscopic percutaneous lung needle aspiration in patients with pneumonia. Chest 98:840–844

    Article  CAS  Google Scholar 

  21. Lichtenstein D, Mezière G, Biderman P, Gepner A, Barré O (1997) The comet-tail artifact: an ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 156:1640–1646

    Article  CAS  Google Scholar 

  22. Lichtenstein D (2002) L’échographie générale en réanimation (General ultrasound in the intensive care unit), 2nd edn. Springer, Heidelberg Paris Berlin New York, pp 1–213

  23. Lichtenstein D, Mezière G (1998) Apprentissage de l’échographie générale d’urgence par le réanimateur. Reanimation Urg 7 [Suppl 1]:108

  24. Dénier A (1946) Les ultrasons, leur application au diagnostic. Presse Med 22:307–308

    Google Scholar 

Download references


We wish to thank David Marsh, PhD, for the translation of this study, Philippe Aegerter, MD, and Gauthier Maillard, MD, for their precious advice. The X-.rays and CTs were taken at the department of Prof. Pascal Lacombe, to whom we are grateful. Lastly, we thank Prof. François Jardin who made this work possible.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Daniel A. Lichtenstein.

Additional information

An editorial regarding this article can be found in the same issue (

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lichtenstein, D.A., Lascols, N., Mezière, G. et al. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med 30, 276–281 (2004).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: