Background <p>This study aimed to evaluate the diagnostic value of lung ultrasound (LUS) in detecting lung necrosis in children with community-acquired pneumonia (CAP), and to determine the sensitivity of the modified Lung Ultrasound Score (m-LUScore) in diagnosing necrotizing pneumonia (NP).</p> Methods <p>Children aged 2 months to 18 years hospitalized with CAP were prospectively enrolled. All participants underwent detailed clinical assessment, laboratory investigations (CBC, CRP), lung ultrasonography, serial chest radiographs, and chest CT when lung necrosis was suspected based on LUS or radiographic findings. The m-LUScore was recorded on the first and fifth days of admission.</p> Results <p>Among 161 children fulfilling the inclusion criteria for CAP, 42 had necrotizing pneumonia and 119 had non-necrotizing pneumonia. On day 1, the mean m-LUScore was significantly higher in NP than in non-NP cases (15.05 vs. 11.27, <i>p</i> &lt; 0.001). A similar difference was observed on day 5 (15.64 vs. 8.65, <i>p</i> &lt; 0.001). Logistic regression analysis identified the m-LUScore on both days as an independent detector of necrotizing pneumonia.</p> Conclusions <p>Lung ultrasound is a sensitive and practical diagnostic tool for identifying necrotizing pneumonia in children. The m-LUScore provides a simple, noninvasive, and cost-effective method for detecting lung necrosis, especially valuable in settings with limited access to CT imaging.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Necrotizing pneumonia is a severe complication of community-acquired pneumonia in children, often requiring CT imaging for confirmation.</p> </ItemContent> <ItemContent> <p>LUS can serve as a reliable and noninvasive alternative to CT for early detection of necrotizing pneumonia in resource-limited settings.</p> </ItemContent> <ItemContent> <p>The modified Lung Ultrasound Score (m-LUScore) can independently detect necrotizing pneumonia as early as the first day of admission.</p> </ItemContent> </UnorderedList></p>