Feasibility and characteristics of contrast-enhanced lung ultrasound in the diagnosis of pulmonary embolism in hospitalized patients.

BACKGROUND AND AIMS: Lung ultrasound (LUS) is a complementary tool in pulmonary embolism (PE) when computed tomography pulmonary angiography (CTPA) is delayed or contraindicated. Contrast-enhanced ultrasound (CEUS) enables real-time perfusion assessment and may help characterize subpleural consolidations. We aimed to describe the feasibility and findings of LUS/CEUS in hospitalized PE and to explore the association between enhancement patterns and atelectasis.

MATERIALS AND

METHODS

Retrospective single-center study (September-December 2025) including Internal Medicine inpatients with a final diagnosis of PE and reference imaging (CTPA and/or V/Q scintigraphy). CEUS was performed with SonoVue®; enhancement was classified as absent, heterogeneous, or homogeneous/hyperenhancing. Descriptive analyses and exploratory Fisher's exact tests were performed in the subgroup with consolidations evaluable by CEUS.

RESULTS

Thirty-four patients were included (38.2% women). CTPA was performed in 33/34 and was positive in 32; two V/Q scans were performed, both high probability. LUS detected subpleural consolidations in 28/34 (82.4%), with a median of 2lesions per patient; localized pleural effusion was found in 24/33 (72.7%). CEUS was performed in 28/33; among patients with consolidation and CEUS (n=28), absent enhancement predominated (64.3%), followed by heterogeneous enhancement (25.0%) and homogeneous/hyperenhancement (10.7%). Homogeneous/hyperenhancement was associated with atelectasis (P=.017), whereas absent enhancement was associated with less atelectasis (P=.026).

CONCLUSIONS

LUS and CEUS were feasible in hospitalized patients with PE, and CEUS provided additional perfusion information for characterizing subpleural consolidations.