Pulmonary consolidation can be visualized in the sonogram if it extends up to the pleura. Pneumonia is visible by ultrasound in up to 83% of cases. The sensitivity increases to 95% for pleural lesions. The pneumonic consolidation is hypoechoic, with a blurred margin, and of inhomogenous echotexture due to multiple lentil sized air inlets, or marked tree shaped, bronchoaerograms. A fluid bronchogram is visualized in 16–92% of pneumonia patients. It arouses suspicion of poststenotic pneumonia. Colour Doppler sonography shows an enhanced blood flow through the regular ramifications of vessels and can be useful in the delineation of pulmonary infarction and cancer. However, these statements are based on initial observations. In patients with pleuritis, ultrasound has a sensitivity of 90%. Interruption of the smooth echogenic pleural line, subpleural consolidations and localized effusion can be observed frequently. For differentiation from pleural pneumonia a chest X-ray is necessary. Pulmonary abcesses are depicted as oval and largely anechoic foci with smooth and hyperechoic borders. They occur in about 6% of patients with lobular pneumonia. Under guidance of ultrasound drainage of abcesses can be performed with a low complication rate. Pleural effusions can be detected in 50% of patients. Ultrasound guided aspiration punction can clarify the etiology of pulmonary infections in 78%. Tuberculosis shows a polymorphic picture in the chest sonogram as in radiography. Numerous subpleural hypoechoic lesions with air inlets or nodular dissemination in the presence of miliary tuberculosis can be seen. A ‘cold’ diffusing abscess is revealed as a round largely anechoic structure.