Percutaneous ultrasonography as imaging modality and sampling guide for pulmonologists.

Ultrasound (US) imaging is gradually progressing into common practice in contemporary pulmonology. Its main applications are to determine the presence and amount of pleural effusions and to guide subsequent treatment interventions. Guidelines recommend the use of US for these indications. Training programs are organized and competency levels are formulated. Image guidance with US to obtain specimens for pathologic and/or microbiological analysis is less extensively practiced by pulmonologists but it is an important tool for tumour staging and diagnosing diseases. Lung tumours in contact with the pleural surface, pleural thickenings, mediastinal tumours and chest wall tumours are conceivable indications for pulmonologists to approach with the help of US visualization. Moreover, sampling of chest disease-related extrathoracal lesions may also be regarded as the working field of the pulmonologist. For example, supraclavicular and axillar lymph node metastasis, and also soft tissue and bone metastases, are lesions encountered during dissemination tests. US-guided biopsy provides not only a diagnosis, but also gives information on the stage of disease in sometimes inaccessible primary lesions. US-guided sampling increases diagnostic efficacy and safety and enables very precise performance of fine-needle aspirations as well as tissue core biopsies.