Bilateral Lung Consolidation with Static and Dynamic Air Bronchograms on Transesophageal Echocardiography

Transesophageal echocardiography (TEE) is performed primarily for cardiac indications, but the acoustic window frequently includes portions of the lung, particularly once normal aeration is lost. We present the intraoperative TEE findings in a 56-year-old woman with ischemic cardiomyopathy who underwent delayed sternal closure after exchange of a durable left ventricular assist device (LVAD) for pump thrombosis. In addition to the expected assessment of device position, flow profiles, interventricular septal position, and right ventricular systolic function, the examination incidentally demonstrated bilateral lung consolidation containing multiple punctate and branching hyperechoic structures. On qualitative assessment of the recorded clips, some structures appeared relatively stationary, whereas others showed apparent movement, suggestive of static and dynamic air bronchograms. Bronchogram displacement was not measured, and no synchronized respiratory tracing was available to confirm inspiratory timing. The coexistence of these appearances may have reflected heterogeneous regional pulmonary pathology and did not, by itself, establish a single diagnosis. The patient subsequently required reintubation, frequent pulmonary toileting, and tracheostomy. These images illustrate that pulmonary abnormalities may appear within the transesophageal window when TEE is otherwise indicated, while emphasizing the limitations of qualitative assessment of bronchogram motion.