An update on the role of ultrasound lung artifacts in the diagnosis of respiratory diseases.

Introduction: Lung ultrasound has consolidated over the years its valuable role in supporting routine clinical activity in different settings. Every disease that alters peripheral airspace geometry can generate a superficial structure with low impedance mismatch which can be capable of trapping ultrasound waves within reflective interfaces.

Areas covered: Qualitative approaches to the description of horizontal and vertical acoustic artifacts have been adopted by physicians for a long time with the consequence of poor diagnostic accuracy and reproducibility. Semi-quantitative methods try to fill the gaps in the operator's qualitative assessments. Finally, quantitative approaches aim to overcome the interpretative biases of visual evaluations of the ultrasound image through measures related to the characteristics of the acoustic traps at the level of the pleural line.

Expert opinion: Current research on the genesis of vertical artifacts and their contribution to the characterization of respiratory diseases is benefiting from the synergies among physicians, engineers, and physicists. The 'acoustic trap' hypothesis, with its effects on the generation of vertical artifacts resulting from the morphology of the trap itself and transmission imaging parameters, represents one of the fronts of ongoing scientific research on innovative methods for the quantitative characterization of lung parenchyma.