SOB and Febrile Lung US Findings

The lung US findings were confusing!

If we break it down by area: 

anteriorly (L1 and R1) there is thin pleura and confluent B lines (typical APO appearance); 

inferior to this (R2 and L2) there is mix of thin and thickened irregular pleura and associated B lines: a mixed pattern of infection and pulmonary oedema.

Laterally at R3 and L3 there is thickened pleura, consolidation and effusion

The consolidation is better defined at L3 and R4. The effusion which seemed to be anechoic in R3/L3 is now seen to contain hypoechoic sediment consistent with an exudate. 

In conclusion, the consolidation and parapneumonic effusion explain the fever, SOB and sepsis. The features of APO on lung US are harder to explain in a patient without a hx of significant heart disease. In an older person, acute heart failure maybe due to an underlying cardiomyopathy pushed into failure due to sepsis or ischaemia. Have a look at the echo and see what you think is the cause.