Chest and lung ultrasound in childhood: applications, role, value and limitations

Abstract

Chest and, in particular, lung ultrasound (LUS) has been an established tool in children for decades. Sonographic assessment of the heart (echocardiography) was actually one of the first applications of ultrasound (US). Other chest US uses that have been recognized for a long time and became part of many standard US textbooks include an assessment of the thymus and mediastinum, pleural effusions, consolidations, diaphragmatic movements and sometimes tumours in adults and children (1)(2)(3)(4)(5)(6)(7)(8)(9) .With time, other applications have been gradually introduced, such as chest wall assessment, including the ribs (especially the cartilaginous portion e.g. for rib anomalies), sternum (e.g. fractures), the musculoskeletal system (e.g. agenesis of the pectoralis muscle) and US of thoracic soft tissue masses, such as lymph nodes, vascular malformations or the breasts (5,9,10) . Chest US can be also used to assess the thoracic vessels for catheter-related thrombosis or embolism. There are multiple accessible sonographic windows for all these applications. In neonates, the non-ossified parts of the thoracic cage allow for further sonographic windows.

Pediatric lung ultrasonography: current perspectives

“…As mentioned, the performance of lung US for central lesions and round atelectasis is inadequate. The scapula in older children also prevents visualization of a significant part of the lung field [ 47 ]. In addition, lung US is not useful for evaluating positions of tubes and lines, such as endotracheal tubes and intercostal drainage tubes, which is an important part of ICU protocols.…”

<p>COVID-19 in Children: An Ample Review</p>

“…56,57 LUS can indicate suggestive signs of interstitial-alveolar damage involving variable consolidations, irregularities of the pleura, nontranslobar consolidation, and consolidation with air bronchogram. 58 However, LUS can detect lung artefacts that are not specific to COVID-19, including consolidations with air bronchogram that occur in pneumonia, 58 subpleural consolidations that occur in pneumonia and bronchiolitis, 59 pleural line irregularities that occur in bronchiolitis, lung fibrosis, pleural malignancies, and COPD, [60][61][62] and B-lines that occur in interstitial alveolar inflammation present in bronchiolitis and viral interstitial cases of pneumonia, 60 as well as in chronic lung pathologies such as fibrosis, 61 cystic fibrosis, 62 and bronchiectasis. 60 The limitations of LUS is relied to the lesion localization, deeper lung lesions have no contact with the pleura and cannot be easily detected as the air is a very weak conductor of ultrasound.…”

Ultrasonography in the Evaluation of Pediatric Chest “Masses”: When to Consider?

“…Addition of color Doppler can be helpful in many ways, including vascularity in neoplasms, vascular channels in congenital lesions like sequestration, differentiating atelectasis/consolidation from neoplasms in few cases. One advantage of using ultrasound in very small infants is that the non‐ossified costal cartilages and sternum provide excellent imaging window; compared to adults 2,3 …”

“…One advantage of using ultrasound in very small infants is that the nonossified costal cartilages and sternum provide excellent imaging window; compared to adults. 2,3…”