Contrast-enhanced thoracic ultrasound

CEUS extends conventional US by enabling real-time assessment of tissue perfusion and vascularity, providing additional diagnostic and procedural information in pleural and peripheral lung disease. This chapter outlines the principles of CEUS, including microbubble contrast agents, equipment requirements and a structured approach to image acquisition and interpretation. In pleural disease, CEUS improves characterisation of pleural thickening, septations and complex effusions, allowing differentiation between vascularised tissue and avascular fluid or debris. In peripheral lung pathology, enhancement patterns support distinction between inflammatory consolidation, malignancy and infarction. CEUS has important interventional applications, particularly in guiding biopsy towards viable tissue and optimising pleural drainage by mapping loculations. The technique demonstrates an excellent safety profile and can be performed at the bedside. Limitations include operator dependence and restriction to pleural-based pathology. Future developments include standardisation, quantitative analysis and integration with artificial intelligence.