Usefulness of Lung Ultrasound in the Diagnosis of Community-acquired Pneumonia in Children

Abstract

LUS is a sensitive diagnostic tool with which to identify pneumonia in children. It is also useful in following up the progress of pneumonia. We suggest that LUS is a complementary tool to chest radiography in the diagnosis of pneumonia in children and that the follow up of pneumonia by LUS can reduce the exposure of children to ionizing radiation.

Performance of lung ultrasonography for the diagnosis of communityacquired pneumonia in hospitalized children

“…It should also be noted that LUS identified 5 additional cases in which no consolidation was visible on chest radiographs. Similar findings on higher performance of LUS as compared to chest radiographs in certain cases have been reported in the literature and among explanations is the reduced dimension of the lung consolidations, too small to be identified by radiography, and the location of the lesions behind the heart or mediastinum [16,24]. Head-to-head comparisons of chest radiological and LUS findings, with chest computed tomography (CT) as a reference standard, are available only in adults and showed a higher accuracy of LUS in the detection of lung changes [25].…”

“…In our study, compared to chest radiographs, LUS correctly identified 57 of the children with radiological pneumonia, while in 15 cases no condensation was visible by LUS. Among the reasons for LUS not detecting the lung modifications are the location of lesions in areas not easily reached by ultrasound beam or lesions of small dimensions that do not extend to pleura [24]. In our study the performance of LUS when using chest radiographs as a reference standard was 79.2% (sensitivity) and 44.4% (specificity), respectively.…”

“…Previous studies performed both in children and adults have shown that LUS is not inferior to chest radiographs in identifying lung abnormalities in patients with a clinical suspicion of pneumonia [15,16,18,19,[21][22][23][24]. Urbanowska et al [19] showed a high agreement between LUS and chest radiographs, with a Cohen kappa coefficient of agreement of 0.89.…”

The Role of Transthoracic Ultrasonography in Predicting the Outcome of Community - Acquired Pneumonia in Hospitalized Children

“…Our multivariate analysis produced the novel finding that a fluid bronchogram is a risk factor for a poor outcome. A fluid bronchogram is an anechoic tubular structure along the bronchial tree and is an established feature of pneumonia that is found in approximately 20% of patients with pneumonia [10,21]. It develops in the early phase of the disease as a result of bronchial secretions or edema [9,21].…”

“…For each case, six sectors of each lung (upper and lower anterior, lateral, and posterior) were examined. The following TUS features of pneumonia were recorded: (1) air bronchogram (Fig 2), the presence of hyperechoic spots caused by small bubbles of trapped air; (2) fluid bronchogram (Fig 3), the presence of mucus-filled tubular structures with echogenic walls, with no color-Doppler signal; (3) increased B-lines (Fig 4), the presence of more than three B-lines per scan; (4) a vascular pattern (Fig 5), the presence of enhanced color-Doppler signal, tree-like vascularity in the consolidation; and (5) pleural effusion (6) [9,10,17,18]. The focal depth of sonomorphology for detecting pneumonia in children is 5 to10 cm.…”