Diagnostic value of lung ultrasonography in children with COVID‐19

Abstract

Background Lung ultrasound (LUS) has been successfully used in the diagnosis of different pulmonary diseases. Present study design to determine the diagnostic value of LUS in the evaluation of children with novel coronavirus disease 2019 (COVID‐19). Methods and Objectives Prospective multicenter study, 40 children with confirmed COVID‐19 were included. LUS was performed to all patients at admission. The chest X‐ray and computed tomography (CT) were performed according to the decision of the primary physicians. LUS results were compared with chest X‐ray and CT findings and diagnostic performance was determined. Results Of the 40 children median (range) was 10.5 (0.4–17.8) years. Chest X‐ray and LUS were performed on all and chest CT was performed on 28 (70%) patients at the time of diagnosis. Sixteen (40%) patients had no apparent chest CT abnormalities suggestive of COVID‐19, whereas 12 (30%) had abnormalities. LUS confirmed the diagnosis of pulmonary involvement in 10 of 12 patients with positive CT findings. LUS demonstrated normal lung patterns among 15 of 16 patients who had normal CT features. The sensitivity and the area under the receiver operating characteristics (ROC) curve (area under the ROC curve) identified by the chest X‐ray and LUS tests were compared and statistically significantly different (McNemar's test: p = .016 and p = .001 respectively) detected. Chest X‐ray displayed false‐negative results for pulmonary involvement in 75% whereas for LUS it was 16.7%. Conclusions LUS might be a useful tool in the diagnostic steps of children with COVID‐19. A reduction in chest CT assessments may be possible when LUS is used in the initial diagnostic steps for these children.

Quantitative assessment of COVID‐19 pneumonia in neonates using lung ultrasound score

“…The peripheral distribution of lesions makes ultrasound detection relatively easier. 10 LUS cannot create direct imaging of the pulmonary parenchyma, but can be used for the diagnosis through utilizing artifacts produced by different pathological changes. The state of aeration of lung parenchyma is a measure of its "air/fluid ratio."…”

“…It indicates that the lung tissue becomes T A B L E 3 Comparison of regional lung ultrasound score between the COVID-19 group and the control group regarding LUS application in the COVID-19 pediatric population, when compared with the gold standard of chest CT, chest X-ray displays falsenegative results for pulmonary involvement in 75%, whereas for LUS it is 16.7%. 10 Furthermore, LUS findings are more sensitive than chest Xray in pediatric patients with COVID-19 infection, especially in the early stage of the disease and in mild cases. 17 Since LUS detects the artifacts generated by the accumulation of fluid, we could rank the artifacts according to the air/liquid ratio and create a score reflecting lung aeration.…”

“…In the current investigation, chest CT or X‐ray demonstrated similar nonspecific or mild changes in neonates. The peripheral distribution of lesions makes ultrasound detection relatively easier 10 …”

Cardio-thoracic imaging and COVID-19 in the pediatric population: A narrative review

“…According to these data LUS, although less sensitive than CT, is more sensitive than chest X-ray[ 27 ]. In the largest multi-center cohort of 40 children with suspected COVID-19 undergoing LUS, the diagnosis of pulmonary involvement was done in 10 out of 12 patients with positive CT findings, in seven of whom chest X-ray was normal[ 28 ].…”

“…Common findings were: A line in 72%, various pattern of B line in 27%, while parenchymal nodular consolidation were more rare as compared with adults (10%)[ 28 ].…”