In moderate to large pleural effusions, it’s not uncommon to see lung atelectasis on the ultrasound. This collapsed lung within the effusion moves with respiration and appears like a jellyfish. Also known as the ‘whale tail’ sign.

Important things to note:

Jellyfish sign favors atelectasis over pneumonia as the collapsed lung can change its shape with respiration whereas pneumonia is more firm.

It also favors transudative etiology of the effusion as the viscosity of exudative effusions tend to hamper mobility of the lung tissue.

Here are more examples

You may also see prominent B-lines in cases of pleural effusion, especially when there is not a lot of atelectasis. Examples: (screen indicator to the right = cardiac preset = towards head in this case)