State of the art: thoracic ultrasound

PURPOSE OF REVIEW: Thoracic ultrasound has continued to expand beyond simple bedside triage into a quantitative, procedure-guiding and increasingly artificial intelligence-augmented tool across pleural and respiratory medicine. This review summarizes the literature published over the past year, highlighting developments in effusion characterization, pneumothorax diagnosis, image-guided pleural procedures, artificial intelligence, training standards, critical care applications, malignant pleural effusion management, and diaphragm/interstitial lung disease assessment. RECENT FINDINGS: Elastography and contrast-enhanced ultrasound have moved from exploratory to comparative and multicentre randomized evaluation for effusion characterization and biopsy guidance. Meta-analyses have reaffirmed the superiority of point-of-care ultrasound over chest radiography for both pneumothorax and thoracentesis guidance. Artificial intelligence tools have shown that they can close the acquisition-skill gap for novice operators, although automated interpretation (particularly B-line quantification) remains inconsistent against expert consensus. A new UK national training standard for pleural procedures has been published, alongside the first validated thoracic-specific competency assessment tool. A large multicentre randomized trial found that a point-of-care ultrasound-driven diagnostic pathway did not improve early discharge rates in emergency department patients with dyspnoea, an important negative finding. Diaphragm and quantitative lung ultrasound continue to accumulate evidence as noninvasive markers of interstitial lung disease severity and ventilator weaning readiness. SUMMARY: The past year's literature confirms thoracic ultrasound's trajectory from a purely diagnostic adjunct towards a quantitative, procedure-integrated and artificial intelligence-supported modality, while also delivering important cautionary and negative findings that temper enthusiasm and clarify where evidence remains immature.