: Pulmonary lesions have broad differential diagnosis including malignant, benign and inflammatory lesions. And have differential diagnosis to be parenchymal, pleural or Mediastinal. Tissue diagnosis is the gold standard for all of these lesions that is used to be obtained either by open lung biopsy, mediastinoscopy or video assisted thoracic surgery (VATS). CT guided biopsy is also a known modality for transthoracic biopsies but its cost, availability, exposure to radiation and shifting of the patient are the main drawbacks of the technique(1), transthoracic ultrasonography is a well-established modality in the evaluation of respiratory disorders. (2)
Interest in transthoracic ultrasound (US) procedures increased after the availability of portable settings. Transthoracic ultrasonography (US) can be performed by personnel with minimum training. Its advantages include immediate application at the point of care, low cost, and lack of radiation (3), imaging-guided percutaneous transthoracic biopsy has become a widely accepted, effective, and safe minimally invasive technique with which tissue specimens can be obtained from a number of different intrathoracic lesions. It facilitates differentiation of primary cancer from distant metastasis or infective and inflammatory lesions, which is crucial for correct management of lung lesions. (4)
US guided transthoracic biopsy of pulmonary lesions is cost effective, portable and readily available modality that not only spare patient from huge radiation but also easy to perform. (5)
Firstly, large vessels and aerated lung parenchyma can easily be detected with ultrasound, secondly, ultrasound can be performed at the bed side and in anybody position allowing for procedures with minimal distress even in patients in poor general conditions, and lastly the integration of ultrasound into a “low-tech” procedures by pulmonologists can reduce the need for more expensive radiological or surgical biopsy. (6)