Professional Documents
Culture Documents
(2013)
Summary. Background: The diagnosis of communityacquired pneumonia (CAP) is based mainly on the patients
medical history and physical examination. However, in
severe cases a further evaluation including chest X-ray
(CXR) may be necessary. At present, lung ultrasound (LUS)
is not included in the diagnostic work-up of pneumonia.
Aim: To describe the ultrasongraphic appearance of CAP at
presentation and during the follow-up. Methods: A total of
102 patients with clinical signs and symptoms suggesting
pneumonia, who underwent a clinically driven CXR, were
evaluated by LUS on the same day. LUS signs of
pneumonia included subpleural lung consolidation, Blines, pleural line abnormalities, and pleural effusion. The
diagnostic gold standard was the expost diagnosis of
pneumonia made by two independent experienced
pediatricians on the basis of clinical presentation, CXR and
clinical course following British Thoracic Guidelines
recommendations. Results: A nal diagnosis of pneumonia
was conrmed in 89/102 patients. LUS was positive for the
diagnosis of pneumonia in 88/89 patients, whereas CXR
was positive in 81/89. Only one patient with normal LUS
examination had an abnormal CXR, whereas 8 patients with
normal CXR had an abnormal LUS. LUS was able to detect
pleural effusion resulting from complicated pneumonia in
16 cases, whereas CXR detected pleural effusion in 3
cases. Conclusions: LUS is a simple and reliable imaging
tool, not inferior to CXR in identifying pleuropulmonary
alterations in children with suspected pneumonia. During
the course of the disease, LUS allows a radiation-free
follow-up of these abnormalities.
Key words: lung ultrasound; pneumonia; B-lines; chest
X-ray.
MD,
INTRODUCTION
In accordance with the British Thoracic
Society
guidelines,
community-acquired
pneumonia (CAP) can be clinically dened as
the presence of signs and symptoms of
pneumonia (such as fever of >38.58C, cough
and respiratory distress) in a previously
healthy child, due to an infection which has
been acquired outside the hospital.1 Chest
X-ray (CXR) is not recommended to
be
performed routinely in uncomplicated cases.
However, in selected cases, the diagnosis of
pneumonia needs to be conrmed with a
CXR.
The use of ultrasound for the evaluation of
the lung is relatively recent. Until a few years
ago, the lung was considered off-limits for
ultrasound.2 This concept, only partially true,
derives from the fact that in the normal lung,
which consists mostly of air, ultrasound
waves are almost completely reected,
without being translated into an image. In a
normal subject the pleura is the only visible
structure, since the high acoustic impedance
of the air below prevents visualization of the
lung parenchyma. In a normal lung,
reverberation artifacts, repetitive and parallel
to the pleura, called A-lines, are
B-lines
are
considered
the
sonographic sign of interstitial syndrome.5
When an infectious process replaces the
alveolar air content with exudate, the lung
parenchyma becomes accessible to the
ultrasound beam because air content is highly
reduced or dissolved, and its sonographic
appearance becomes similar to that of a
parenchymal organ. If the consolidation
reaches the pleura, it is possible to visualize
the lesion, which has a random conformation
with
irregular, blurred and sometimes
indistinct edges. Multiple lenticular echoes,
representing air trapped in the smaller
airways, are also frequently observed (Fig.
3).6
Lung ultrasound (LUS) is a very easy and
Lung ultrasound
Pneumonia
Chest X-ray
CXR Examination
1.
LUS Findings
On day 1, LUS ndings in children and
adolescents with pneumonia were as follows:
In 83/89 patients we found subpleural lung
Fig.
4.
Lung
consolidation:
Internal
hyperechoic linear elements, representing
air bronchogram s.
Fig. 5. Conuent B-lines, dened as areas
of white lung, an expression of perilesional
inammatory edema.
Fig. 8. In this patient, pleural abnormalities were the only LUS sign on day 1 (A);
pulmonary consolidation appeared near the pleural lesion at the rst follow -up (B).
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