The bedside assessment of pulmonary congestion is undergoing conceptual consolidation: lung ultrasound (LUS) has evolved from being merely an “adjunct” tool to assuming a central role in the identification of extravascular fluid and aeration patterns, with important diagnostic, prognostic, and therapeutic implications. The article by Donmez et al. directly discusses the role of LUS in the assessment of pulmonary edema in children with congenital heart disease (CHD). In a retrospective cohort of 62 children, the study observed pulmonary edema in 53% by LUS and in 58% by radiography. Furthermore, the presence of edema by LUS was associated with clinically relevant variables in the clinical picture, such as recurrent respiratory infections, low weight, and elevated BNP levels. These findings reinforce that LUS adds objective and reproducible information to the care of children, in a context where clinical examination can be hampered by low cooperation and bedside radiography may have reduced accuracy due to positioning limitations and technical quality.

In adults with heart failure, the usefulness of LUS for pulmonary congestion is supported by several clinical studies demonstrating high diagnostic performance and correlation with outcomes. B-lines reflect increased extravascular fluid and, when diffusely present, reclassify the differential diagnosis of dyspnea. Comparison between LUS, biomarkers, and clinical assessment in an outpatient setting has shown that the burden of B-lines can detect subclinical congestion and anticipate the possibility of decompensation.^, In an acute setting, the systematic implementation of LUS improves diagnostic accuracy for decompensated heart failure, and prognostic studies associate congestion detected by LUS with worse short- and long-term outcomes. Reviews and perspective papers in cardiology have highlighted LUS as a rapid, reproducible, and low-cost diagnostic modality.

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Ultrasound and echocardiography with Doppler studies have represented, over the last few decades, highly noteworthy advances in medical practice in general. Particularly in internal medicine, they have promoted a true revolution in daily work and are currently considered a fundamental tool in clinical practice. This application of the method includes both urgent care and outpatient settings.^,

In emergency scenarios, the initial establishment of the FAST (Focused Assessment with Sonography in Trauma) protocol for systematized trauma care made it possible to popularize the use of the method and served as a basis for multiple applications. In expanded application in emergency medicine, the sequence has included implementation of the RUSH (Rapid Ultrasound for Shock and Hypotension) and C.A.U.S.E. (Cardiac Arrest Ultrasound Exam) protocols,^, progressively gaining ground as a multipurpose tool for use in medical education, research, and outpatient medical practice.

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