Lung B-line artefacts and their use.
BACKGROUND
The analysis of lung artefacts has gained increasing importance as markers of lung pathology. B-line artefact (BLA), caused by a reverberation phenomenon, is the most important lung artefact. In this review, we discuss the current role of BLA in pneumology and explore open questions of the published consensus.


METHODS
We summarized current literature about BLA. Also, we presented observations on healthy subjects and patients with interstitial syndrome (pulmonary fibrosis and edema), to investigate technical factors influencing BLA visualization.


RESULTS
BLA imaging is influenced by more factors than recently assumed. When multiple BLA is visualized in the lung, they represent a sign of increased density due to the loss of aeration in the lung periphery. This condition may indicate different diseases including cardiogenic pulmonary edema, diffuse or focal interstitial lung diseases (ILD), infections and acute respiratory distress syndrome (ARDS). Correct interpretation of BLA in lung ultrasound is strongly influenced by associated sonographic signs and careful integration of all relevant clinical information.


CONCLUSIONS
BLA is useful to monitor clinical response, and may become crucial in directing the diagnostic process. Further research is warranted to clarify technical adjustments, different probe and machine factors that influence the visualization of BLA.
1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Christoph F
CF
Dietrich
1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Gebhard
G
Mathis
1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Michael
M
Blaivas
1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Giovanni
G
Volpicelli
1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Armin
A
Seibel
1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Daniel
D
Wastl
1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Nathan S S
NS
Atkinson
1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Xin-Wu
XW
Cui
1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Mei
M
Fan
1 Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China ; 2 Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Deutschland ; 3 Praxis for Internal Medicine, Bahnhofstraße 16, 6830 Rankweil, Austria ; 4 University of South Carolina School of Medicine, Department of Emergency Medicine, Piedmont Hospital, Newnan Georgia, USA ; 5 Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy ; 6 Diakonie Klinikum Jung-Stilling, Abteilung für Anästhesiologie, Intensiv- und Notfallmedizin, 57074 Siegen, Deutschland ; 7 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK ; 8 Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China ; 9 Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Dong
D
Yi
Guidelines; atelectasis; consolidations; interstitial syndrome; malignancies; pleural effusion (PE); pneumonia; pulmonary thromboembolism