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Transcutaneous Contrast-Enhanced Sonography of Peripheral Lung Lesions

¹ All authors: Department of Internal Medicine and Department of Hematology, Philipps-University Marburg, Marburg, Germany 35033.

View larger version (113K): [in a new window]   Fig. 1A —35-year-old man with pleural effusion and compression atelectasis. B-mode sonography shows pleural effusion (E), atelectasis (A), and spleen (S).

View larger version (78K): [in a new window]   Fig. 1B —35-year-old man with pleural effusion and compression atelectasis. Contrast-enhanced sonography shows short time to enhancement (2 s), suggesting pulmonary arterial supply. Arrow shows marked enhanced vessel.

View larger version (105K): [in a new window]   Fig. 1C —35-year-old man with pleural effusion and compression atelectasis. During parenchymal phase (1 min), hyperechoic tissue enhancement compared with splenic (S) enhancement (1 min) is seen.

View larger version (136K): [in a new window]   Fig. 2A —68-year-old man with hypernephroma and histologically proven pleural-based metastasis. B-mode sonography shows nodule of complex echogenicity (N).

View larger version (80K): [in a new window]   Fig. 2B —68-year-old man with hypernephroma and histologically proven pleural-based metastasis. Contrast-enhanced sonography shows delayed time to enhancement (7 s), suggesting bronchial arterial supply. Arrow shows small enhanced vessel.

View larger version (104K): [in a new window]   Fig. 2C —68-year-old man with hypernephroma and histologically proven pleural-based metastasis. During parenchymal phase (1 min), tissue enhancement is seen.

View larger version (85K): [in a new window]   Fig. 2D —68-year-old man with hypernephroma and histologically proven pleural-based metastasis. Enhancement of spleen (S) is isoechoic compared with enhancement of metastasis seen in C.

View larger version (132K): [in a new window]   Fig. 3A —32-year-old woman with pulmonary embolism confirmed by CT. B-mode sonography shows triangular pulmonary lesion (IN).

View larger version (114K): [in a new window]   Fig. 3B —32-year-old woman with pulmonary embolism confirmed by CT. Contrast-enhanced sonography shows no tissue enhancement (4 min) of lesion.

View larger version (69K): [in a new window]   Fig. 3C —32-year-old woman with pulmonary embolism confirmed by CT. Marked splenic (S) tissue enhancement provides reference.

View larger version (140K): [in a new window]   Fig. 4A —38-year-old man with testicular cancer and histologically proven lung metastasis. B-mode sonography shows lung nodule (N).

View larger version (113K): [in a new window]   Fig. 4B —38-year-old man with testicular cancer and histologically proven lung metastasis. Contrast-enhanced sonography shows no tissue enhancement (5 min) of lesion.

View larger version (144K): [in a new window]   Fig. 5A —15-year-old boy with pleurisy, suggesting pleuropneumonia. B-mode sonography shows pleural lesion (arrow).

View larger version (130K): [in a new window]   Fig. 5B —15-year-old boy with pleurisy, suggesting pleuropneumonia. Contrast-enhanced sonography shows isoechoic enhancement (1 min) of infiltrated lung (LU) in early parenchymal phase compared with splenic (S) enhancement (1 min).

View larger version (116K): [in a new window]   Fig. 5C —15-year-old boy with pleurisy, suggesting pleuropneumonia. Contrast-enhanced sonography shows hyperechoic enhancement (5 min) of infiltrated lung (LU) in late parenchymal phase compared with splenic (S) enhancement (5 min).

View larger version (136K): [in a new window]   Fig. 6A —71-year-old man with pneumonia. B-mode sonography shows triangular lesion (P) with air bronchogram.

View larger version (129K): [in a new window]   Fig. 6B —71-year-old man with pneumonia. Contrast-enhanced sonography shows short time to enhancement. In early parenchymal phase, marked tissue enhancement is seen (20 s).

View larger version (133K): [in a new window]   Fig. 7A —72-year-old man with pneumonia. B-mode sonography shows lesion in upper lobe with air bronchogram.

View larger version (123K): [in a new window]   Fig. 7B —72-year-old man with pneumonia. Contrast-enhanced sonography shows short time to enhancement (2 min). In parenchymal phase, hypoechoic tissue enhancement is seen with anechoic areas caused by necrosis (N) (arrows).

View larger version (122K): [in a new window]   Fig. 7C —72-year-old man with pneumonia. Marked splenic (S) tissue enhancement provides reference.

View larger version (129K): [in a new window]   Fig. 8A —52-year-old woman with ovarian cancer and exudative effusion without evidence of lung metastases by CT. B-mode sonography shows round atelectasis (A) and pulmonary effusion (E).

View larger version (106K): [in a new window]   Fig. 8B —52-year-old woman with ovarian cancer and exudative effusion without evidence of lung metastases by CT. Contrast-enhanced sonography shows short time to enhancement (1 min). In parenchymal phase, isoechoic tissue enhancement compared with splenic enhancement (S) is seen.

View larger version (141K): [in a new window]   Fig. 9A —71-year-old woman with lung cancer. B-mode sonography shows atelectasis (A) of left upper lobe.

View larger version (111K): [in a new window]   Fig. 9B —71-year-old woman with lung cancer. Contrast-enhanced sonography shows short time to enhancement (3 s) with treelike enhancement of pulmonary vessels in arterial phase (arrow).

View larger version (136K): [in a new window]   Fig. 9C —71-year-old woman with lung cancer. In parenchymal phase, homogeneous tissue enchancement (35 s) is seen with demarcation of hypoechoic central lesion (TU).

View larger version (122K): [in a new window]   Fig. 10A —64-year-old man with malignant melanoma and lung metastases. B-mode sonography shows pleural effusion (E) and inhomogeneous atelectasis (A).

View larger version (117K): [in a new window]   Fig. 10B —64-year-old man with malignant melanoma and lung metastases. Contrast-enhanced sonography shows short time to enhancement (3 min). In parenchymal phase, marked tissue enhancement is seen with demarcation of hypoechoic paranchymal lesion (M).

View larger version (144K): [in a new window]   Fig. 11A —48-year-old man with lung cancer. B-mode sonography shows inhomogeneous atelectasis (AT). S = spleen.

View larger version (134K): [in a new window]   Fig. 11B —48-year-old man with lung cancer. Contrast-enhanced sonography shows short time to enhancement (1 min). In parenchymal phase, isoechoic tissue enhancement compared with spleen (S) is seen. Demarcation of areas with anechoic enhancement suggests necrosis (N).

View larger version (137K): [in a new window]   Fig. 12A —53-year-old woman with fever and lung cancer. B-mode sonography shows inhomogeneous atelectasis (AT).

View larger version (97K): [in a new window]   Fig. 12B —53-year-old woman with fever and lung cancer. Contrast-enhanced sonography shows delayed time to enhancement (1 min). In parenchymal phase, reduced tissue enhancement is seen with demarcation of anechoic area, suggesting lung abscess (A).

View larger version (110K): [in a new window]   Fig. 12C —53-year-old woman with fever and lung cancer. In late parenchymal phase, hypoechoic enhancement (4 min) of atelectasis (AT) compared with splenic enhancement (S) is seen.

View larger version (134K): [in a new window]   Fig. 13A —31-year-old man with Kaposi sarcoma of lung. B-mode sonography shows homogeneous lung lesion.

View larger version (118K): [in a new window]   Fig. 13B —31-year-old man with Kaposi sarcoma of lung. Contrast-enhanced sonography shows short time to enhancement. In parenchymal phase, hypoechoic tissue enhancement is seen. Demarcation of areas with anechoic enhancement (1 min) suggests tumor necrosis (N).

View larger version (123K): [in a new window]   Fig. 13C —31-year-old man with Kaposi sarcoma of lung. Marked splenic (S) tissue enhancement (2 min) provides reference.

View larger version (117K): [in a new window]   Fig. 14A —73-year-old woman with pleurisy. B-mode sonography shows hypoechoic pleural lesion.

View larger version (95K): [in a new window]   Fig. 14B —73-year-old woman with pleurisy. Contrast-enhanced sonography shows short time to enhancement (45 s). In parenchymal phase, marked tissue enhancement is seen, suggesting pleuropneumonia.

View larger version (143K): [in a new window]   Fig. 15A —70-year-old man with Churg-Strauss syndrome. B-mode sonography shows pleural-based nodule (N).

View larger version (128K): [in a new window]   Fig. 15B —70-year-old man with Churg-Strauss syndrome. Contrast-enhanced sonography shows delayed time to enhancement (1 min). In parenchymal phase, complex tissue enhancement (arrow) is seen.

View larger version (138K): [in a new window]   Fig. 16A —53-year-old woman with Hodgkin's disease and histologically proven lung involvement. B-mode sonography shows pleural-based nodule (N).

View larger version (152K): [in a new window]   Fig. 16B —53-year-old woman with Hodgkin's disease and histologically proven lung involvement. Contrast-enhanced sonography shows delayed time to enhancement (1 min). In parenchymal phase, marked tissue enhancement is seen.

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