{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T19:58:53Z","timestamp":1793735933913,"version":"4.6.1"},"reference-count":78,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Contrast-enhanced ultrasound (CEUS) recently emerged as a valuable imaging modality for evaluating pleuropulmonary diseases. By combining morphological information from conventional B-mode ultrasound with real-time assessment of microvascular perfusion, CEUS can provide functional insights that improve diagnostic accuracy, guide interventions, and support patient surveillance. Methods: This review summarizes the current evidence on the use of CEUS in major pleuropulmonary disorders, including pneumonia, pleural effusion, pulmonary embolism, neoplasms, and COVID-19-related lung injury. The most relevant clinical studies and meta-analyses were analyzed, focusing on CEUS parameters, diagnostic performance, and integration with other imaging techniques. Results: CEUS enables the differentiation between inflammatory, ischemic, and malignant lesions through qualitative and quantitative analyses of enhancement patterns. Early and homogeneous enhancement is typical of inflammatory or infectious processes, whereas heterogeneous or delayed enhancement with early washout strongly suggests malignancy or ischemia. In pneumonia and pleural infections, CEUS identifies non-perfused or necrotic areas, guiding drainage and evaluating therapeutic responses. In pulmonary embolism, it reveals avascular consolidations corresponding to infarction, even when CT angiography is inconclusive. For peripheral lung tumors, CEUS assesses angiogenesis and vascular supply, correlating perfusion parameters with histopathology, and improving biopsy targeting. Furthermore, in COVID-19 pneumonia, CEUS can detect microvascular alterations related to thrombosis and fibrosis. Conclusions: CEUS is a safe, noninvasive, and radiation-free technique that provides unique real-time information on pulmonary perfusion. Its integration with conventional ultrasound enhances diagnostic precision, optimizes interventional guidance, and allows for dynamic monitoring of treatment response. Future developments in quantitative analysis, artificial intelligence, and targeted contrast agents are expected to further expand CEUS clinical applications in pleuropulmonary imaging.<\/jats:p>","DOI":"10.3390\/jcm15062292","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T12:42:16Z","timestamp":1773751336000},"page":"2292","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Role of CEUS in the Diagnosis and Follow-Up of Pleuropulmonary Diseases and Interventional Procedures"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9303-7790","authenticated-orcid":false,"given":"Andrea","family":"Boccatonda","sequence":"first","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant\u2019Orsola-Malpighi, Via Massarenti n 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2809-1658","authenticated-orcid":false,"given":"Alice","family":"Brighenti","sequence":"additional","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant\u2019Orsola-Malpighi, Via Massarenti n 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4784-1950","authenticated-orcid":false,"given":"Daniel","family":"Piamonti","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy"},{"name":"Pulmonary Critical Care Unit, Policlinico Umberto I Hospital, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2076-7319","authenticated-orcid":false,"given":"Giulia","family":"Bandini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Hospital Careggi, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0381-8302","authenticated-orcid":false,"given":"Giulia","family":"Fiorini","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Vetrugno","sequence":"additional","affiliation":[{"name":"Emergency Department, Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, 33028 Tolmezzo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0753-5572","authenticated-orcid":false,"given":"Giampietro","family":"Marchetti","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, ASST Spedali Civili, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esterita","family":"Accogli","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5555-0745","authenticated-orcid":false,"given":"Carla","family":"Serra","sequence":"additional","affiliation":[{"name":"Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant\u2019Orsola-Malpighi, Via Massarenti n 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5573-4536","authenticated-orcid":false,"given":"Damiano","family":"D\u2019Ardes","sequence":"additional","affiliation":[{"name":"Institute of \u201cClinica Medica\u201d, Department of Medicine and Aging Science, Gabriele d\u2019Annunzio University of Chieti and Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e230171","DOI":"10.1148\/rg.230171","article-title":"Conventional and Contrast-enhanced US of the Lung: From Performance to Diagnosis","volume":"44","author":"Cornellas","year":"2024","journal-title":"Radiographics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/j.ultrasmedbio.2021.11.014","article-title":"WFUMB Technological Review: How to Perform Contrast-Enhanced Ultrasound of the Lung","volume":"48","author":"Zadeh","year":"2022","journal-title":"Ultrasound Med. 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