We will discuss the evolution of lung ultrasound beginning over 30-years ago in 1986 and some important findings that led to its clinical use in people and animals. Following the short introduction, we will review how to perform Vet BLUE and its 9 unique regional views, the lung ultrasound artifacts of wet lung versus dry lung, the novel Vet BLUE B-line scoring and its inherent severity scoring system for assessing and tracking respiratory patients. Vet BLUE is advantageous as a unique and novel regional, pattern-based approach for developing a working diagnosis for common small animal respiratory conditions. Comparisons to radiography and computed tomography will be made discussing advantages and limitations of the Vet BLUE approach. Practical everyday cases are used to show this approach’s clinical impact.