Background: Pulmonary congestion is associated with an increased risk for adverse outcomes and mortality in heart failure (HF) patients, whether with preserved or reduced ejection fraction including mild reduced EF (HFpEF or HFrEF including HFmrEF). Lung ultrasound has been described as more sensitive for detecting pulmonary congestion compared to traditional imaging. Herein, we investigated the role of lung ultrasound as a predictor for outcomes in Egyptian HF patients. Methods: Eighty HF were enrolled in our prospective trial, and they were divided into two groups; HFrEF (50 cases) and HFpEF (30 cases). Echocardiography was performed at patient admission, while lung ultrasound was done at admission and before discharge. Ultrasonographic findings were correlated with three-month outcomes. Results: The number of B-lines expressed a significant rise in HFrEF patients only in Zone 1, and that was evident on admission and before discharge. Nonetheless, the remaining lung zones had comparable B-lines between HFrEF and HFpEF patients. The three-month followup revealed the incidence of decompensated HF in 22% and 16.7% of HFrEF and HFpEF patients, respectively (p = 0.564). Only one patient died in the HFrEF group (2%). Having Blines ≥ 30 at admission was associated with a significant increase in the incidence of decompensation in the short term (p < 0.001), and that was evident in both groups.