Why look for artifacts alone when the original is visible?

The study concerning the relevance of lung ultrasound in the diagnosis of acute respiratory failure by Lichtenstein and Mezière in CHEST (July 2008) 1 raises a few basic questions. First of all, there is a technical problem: modern ultrasound systems work on the basis of noise reduction. As a result, one sees fewer artifacts. Artifacts are a fundamental component of ultrasound imaging, for instance, the sonic shadow in the case of gallstones. However, the value of the method lies in its visualization of parenchyma, for instance, that of the liver. On chest ultrasonography, the presence of artifacts permits the diagnostician to confi rm or rule out a pneumothorax (the absence of gliding, a large number of horizontal reverberations, and lung point) with a high accuracy. However, comet tails are found in a large number of interstitial lung processes, ranging from lung edema of various causes to fi brosis. One sees that the lung is diseased, but the spectrum of the etiologic characteristics of disease is very wide. Second, one should not confi ne oneself to alveolar consolidations. It is a well-known fact that subpleural consolidations can be differentiated on the simple ultrasound B-mode image. Pneumonias can be directly visualized with a sensitivity of 90% and lung embolisms with an accuracy of 80%. 2 , 3 Why select the anterior access alone when the largest portions of the lung are seen by the dorsal access? Why look for artifacts alone when the original is visible? Referring to horizontal and vertical reverberations as A and B lines by way of terminology may well be meaningful for teaching purposes. However, further abbreviations would make the decision trees unnecessarily complex in terms of thought and action.