• Mathieu Echivard, Daniel A Lichtenstein, Adrian Lala, Anais Perez Sanchez, and Nicolas Girerd.
• Service de Cardiologie, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France.
• Crit. Care Med. 2019 Oct 1; 47 (10): e841-e844.

ObjectivesLung ultrasound has shown increasing diagnostic value in many lung diseases and has become an efficient tool in the management of dyspnea. In the present case report, we describe a new ultrasound feature of potential interest.Data SourcesClinical observation of a patient.Study SelectionCase report.Data ExtractionData were extracted from medical records, after obtaining consent from the patient's family. Illustrations were extracted from the imaging software and a video device.Data SynthesisA 56-year-old man was admitted with pneumonia of adverse outcome. Lung ultrasound, a method increasingly considered as a bedside gold standard in critically ill patients due to its overwhelming advantages, was the only tool able to specify the lung injuries. We describe herein a distinctive sign unequivocally evoking a destructive process suggestive of pulmonary gangrene, a variant of the fractal sign combining a lung consolidation with an underlying heterogeneous free fluid.ConclusionsLung ultrasound may help highlight pulmonary gangrene, a poorly-known disease, with this new ultrasonographic description. The next step will be to ascertain the relation between this new ultrasound feature and pulmonary gangrene and to assess how this bedside diagnosis could impact the prognosis of the disease.

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