Terminology of pleural artifacts in ultrasound: a Tower of Babel

Objectives Lung ultrasound (LUS) has evolved into a widely used tool for the assessment of pleural artifacts (PA), yet the field remains trapped in a terminology Tower of Babel. A proliferation of terms has fragmented the literature, obstructed communication, and hindered progress toward standardization. Materials and methods Between January and February 2025, a structured but unsystematic literature review was conducted via Google Scholar to identify terminology used for PA. Twelve distinct terms were identified: A-lines, B-lines, comet-tail artifact, vertical artifact, horizontal artifact, reverberation artifact, mirror-image artifact, ring-down artifact, interstitial syndrome, wet lung, dry lung, and aurora sign. Relevant publications were selected based on predefined keyword combinations and expert review. An analysis of terminology usage was performed for 2000–2025. Results The analysis revealed an increase in PA mentions from 751 (2000–2004) to 16,269 (2020–2025), representing more than a twenty-fold increase (+2,066%). Eleven of the twelve PAs showed significant annual growth; only the aurora sign did not demonstrate a consistent increase in usage over time. Conclusion The simultaneous increase in nearly all terms for the same physical phenomena reflects a persistent lack of consensus in the literature. While other imaging fields, such as computed tomography, have adopted standardized glossaries like that of the Fleischner Society, LUS remains without a unified terminology. A shared, technology-independent vocabulary is needed to ensure clarity, comparability, and future progress in LUS. Critical relevance statement A shared, technology-independent vocabulary is needed to ensure clarity, comparability, and future progress in lung ultrasound (LUS). Key Points Standardized studies and methodological progress require a unified nomenclature. The ultrasound community currently lacks consistent terminology for pleural artifacts (PA). A consensus, unified terminology for PA is urgently needed.