Terminology of pleural artifacts in ultrasound: a Tower of Babel

TL;DR

The paper highlights the lack of standardized terminology for pleural artifacts in lung ultrasound, which hinders communication and progress in the field.

Contribution

The study identifies twelve distinct terms for pleural artifacts and emphasizes the urgent need for a unified, standardized nomenclature in lung ultrasound.

Findings

Twelve distinct terms for pleural artifacts were identified, leading to fragmented literature.

Mentions of pleural artifacts increased over 2,000% from 2000–2004 to 2020–2025.

Only the 'aurora sign' did not show consistent usage growth, while all others increased simultaneously.

Abstract

Lung ultrasound (LUS) has evolved into a widely used tool for the assessment of pleural artifacts (PA), yet the field remains trapped in a terminology Tower of Babel. A proliferation of terms has fragmented the literature, obstructed communication, and hindered progress toward standardization.

Between January and February 2025, a structured but unsystematic literature review was conducted via Google Scholar to identify terminology used for PA. Twelve distinct terms were identified: A-lines, B-lines, comet-tail artifact, vertical artifact, horizontal artifact, reverberation artifact, mirror-image artifact, ring-down artifact, interstitial syndrome, wet lung, dry lung, and aurora sign. Relevant publications were selected based on predefined keyword combinations and expert review. An analysis of terminology usage was performed for 2000–2025.

The analysis revealed an increase in PA mentions from 751 (2000–2004) to 16,269 (2020–2025), representing more than a twenty-fold increase (+2,066%). Eleven of the twelve PAs showed significant annual growth; only the aurora sign did not demonstrate a consistent increase in usage over time.

The simultaneous increase in nearly all terms for the same physical phenomena reflects a persistent lack of consensus in the literature. While other imaging fields, such as computed tomography, have adopted standardized glossaries like that of the Fleischner Society, LUS remains without a unified terminology. A shared, technology-independent vocabulary is needed to ensure clarity, comparability, and future progress in LUS.

A shared, technology-independent vocabulary is needed to ensure clarity, comparability, and future progress in lung ultrasound (LUS).

Standardized studies and methodological progress require a unified nomenclature.The ultrasound community currently lacks consistent terminology for pleural artifacts (PA).A consensus, unified terminology for PA is urgently needed.

Standardized studies and methodological progress require a unified nomenclature.

The ultrasound community currently lacks consistent terminology for pleural artifacts (PA).

A consensus, unified terminology for PA is urgently needed.

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