CEUS guided percutaneous biopsy of lung adenocarcinomas. (a) Gray-scale ultrasound detected a hypoechoic and homogeneous lesion in the upper lobe of right lung; no necrotic area was shown with conventional ultrasound. (b) After injection of SonoVue, the lesion showed rapid and heterogeneous enhancement. The enhancement began approximately at 16 sec; a small anechoic necrotic area was detected in the lesion (arrow). (c) Enhancement of lesion remained for approximately 115 sec, with unenhanced necrotic area inside it (arrow). (d) After CEUS, 16-gauge core needle percutaneous biopsy was performed successfully in the active areas of the lesion. The necrotic area was avoided during the real-time ultrasound guidance. (e) Biopsy histopathological diagnosis revealed it was a lesion of lung adenocarcinomas.