Lung Ultrasound in Pediatric Asthma - Characterizing Baseline Findings Outside of Acute Exacerbations

Background: Lung ultrasound (LUS) has been shown to be an effective tool to rapidly diagnose certain causes of pediatric respiratory distress in the emergency department. However, very little is known about LUS findings in pediatric asthma outside of acute exacerbations. Objectives: The primary objective of this study was to characterize LUS findings in a cohort of pediatric patients with a definitive diagnosis of asthma, outside of an asthma exacerbation. Methods: Eligible patients, aged 6 to 17 years old and diagnosed with asthma, underwent LUS during an outpatient visit. LUS was conducted using a six-zone scanning protocol. A positive LUS was defined by one or more of the following: ≥3 B-lines per intercostal space, pulmonary consolidation and/or pleural anomaly. Images were interpreted by an expert sonographer blinded to patient clinical characteristics. Results: 52 patients were included. 10/52 patients had a positive LUS (19.2%, 95CI 8.3-30.1%). Of those with positive LUS findings, 8 had B lines, 7 had consolidations <1cm, 1 had a pleural line abnormality and 1 had a consolidation >1cm. Positive findings were seen in the right anterior and lateral zones in 60% of participants and were limited to 1-2 intercostal spaces within one lung zone in 100% of participants. Conclusion: To our knowledge, this is the first report of LUS findings in outpatient pediatric asthma. Positive LUS findings in asthmatic children can be seen outside of acute exacerbations. Such findings need to be taken into consideration when using LUS for the acute evaluation of a pediatric patient with asthma.

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90 Lung ultrasound in pediatric asthma patients: A pilot study characterizing findings at baseline stat

Paediatrics & Child Health ◽

10.1093/pch/pxab061.072 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e65-e66

Author(s):

Noah Marzook ◽

Alexander Dubrovsky

Keyword(s):

Pediatric Patients ◽

Lung Ultrasound ◽

Demographic Data ◽

Tertiary Care ◽

Challenge Test ◽

Primary Objective ◽

Upper Respiratory Tract ◽

The Past ◽

Asthma Patients ◽

B Lines

Abstract Primary Subject area Emergency Medicine - Paediatric Background Unlike the lung ultrasound (LU) findings of pneumonia, bronchiolitis, pleural effusions and pneumothorax, which have all been well described, the sonographic pattern of asthma remains unclear. Previous pediatric studies have shown that pediatric patients with acute asthma exacerbations had positive LU findings. It is also unclear whether these findings were the result of acute infections associated with the exacerbation or if the findings would be present at baseline, outside an exacerbation in an asthmatic patient. Objectives The primary objective of this study is to characterize lung ultrasound (LU) findings in stable asthma pediatric patients presenting in a tertiary care asthma or respiratory clinic. Design/Methods Eligible patients >6 years of age, underwent a LU by the study sonographer between December 19, 2017 to June 25, 2019, during their regular follow up visit at the pulmonology clinic or scheduled pulmonary function test. Patients were defined as asthmatic if they had a positive methacholine challenge test (MCT) or spirometry at the day of the visit or in the past. Patients were excluded if they had an upper respiratory tract infection in the past 4 weeks, or had any other known pulmonary diseases. Baseline demographic and asthma severity (ISAAC score, ACQ-7) questionnaires were filled out by the patients, following which they underwent a LU by a novice sonographer using a 6-zone protocol. A blinded expert sonographer interpreted the images offline. A positive LU was defined as presence of more than 3 B-lines, consolidation (<1cm or >1cm), absent lung slide, and/or presence of pleural fluid. Results Fifty-two patients were enrolled in the study and 19.2% (CI 8.31-30.15) of the asthma patients had positive LU findings. The positive LU findings were diverse including B-lines (80%), small consolidation (80%), pleural line anomalies (10%). Positive LU findings were not correlated to any demographic value. Conclusion In our study, 19.2% of asthma patients at baseline have a positive LU. Lung consolidations larger than 1 cm were rarely seen. There were no significant differences between demographic data in asthmatic patients with positive compared to those with negative LUS. This positive LU scan rate is in keeping with a prior study on LU in pediatrics.

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Patients in intensive care unit for COVID-19 pneumonia: the lung ultrasound patterns at admission and discharge. An observational pilot study

The Ultrasound Journal ◽

10.1186/s13089-021-00213-x ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Persona Paolo ◽

Valeri Ilaria ◽

Zarantonello Francesco ◽

Forin Edoardo ◽

Sella Nicolò ◽

...

Keyword(s):

Intensive Care ◽

Lung Ultrasound ◽

Low Cost ◽

Low Frequency ◽

Specific Pattern ◽

University Hospital ◽

Left Hemithorax ◽

Significant Difference ◽

The Right ◽

B Lines

Abstract Background During COVID-19 pandemic, optimization of the diagnostic resources is essential. Lung Ultrasound (LUS) is a rapid, easy-to-perform, low cost tool which allows bedside investigation of patients with COVID-19 pneumonia. We aimed to investigate the typical ultrasound patterns of COVID-19 pneumonia and their evolution at different stages of the disease. Methods We performed LUS in twenty-eight consecutive COVID-19 patients at both admission to and discharge from one of the Padua University Hospital Intensive Care Units (ICU). LUS was performed using a low frequency probe on six different areas per each hemithorax. A specific pattern for each area was assigned, depending on the prevalence of A-lines (A), non-coalescent B-lines (B1), coalescent B-lines (B2), consolidations (C). A LUS score (LUSS) was calculated after assigning to each area a defined pattern. Results Out of 28 patients, 18 survived, were stabilized and then referred to other units. The prevalence of C pattern was 58.9% on admission and 61.3% at discharge. Type B2 (19.3%) and B1 (6.5%) patterns were found in 25.8% of the videos recorded on admission and 27.1% (17.3% B2; 9.8% B1) on discharge. The A pattern was prevalent in the anterosuperior regions and was present in 15.2% of videos on admission and 11.6% at discharge. The median LUSS on admission was 27.5 [21–32.25], while on discharge was 31 [17.5–32.75] and 30.5 [27–32.75] in respectively survived and non-survived patients. On admission the median LUSS was equally distributed on the right hemithorax (13; 10.75–16) and the left hemithorax (15; 10.75–17). Conclusions LUS collected in COVID-19 patients with acute respiratory failure at ICU admission and discharge appears to be characterized by predominantly lateral and posterior non-translobar C pattern and B2 pattern. The calculated LUSS remained elevated at discharge without significant difference from admission in both groups of survived and non-survived patients.

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Quick diagnostic and management community acquired pneumonia at Sumbawa hospital: a case report

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20185184 ◽

2018 ◽

Vol 7 (1) ◽

pp. 297

Author(s):

Muhammad Ahmad Syammakh ◽

Elim Jusri ◽

Gede Agung Setya ◽

Made Aryadi Sukartika

Keyword(s):

Emergency Department ◽

Lung Ultrasound ◽

Lower Lobe ◽

Symptomatic Treatment ◽

Community Acquired Pneumonia ◽

Pulmonary Parenchyma ◽

The Right ◽

Hospital Acquired ◽

B Lines ◽

Good Oxygenation

Pneumonia is most common cause of respiratory distress an infection of the pulmonary parenchyma. Despite being the cause of significant morbidity and mortality, it is often misdiagnosed, mistreated, and underestimated. Pneumonia historically was Typically classified as community-acquired (CAP), hospital-acquired (HAP), or ventilator-associated (VAP). A 68-year-old male was sent to the emergency department from clinic with an oxygen saturation of 86%. She has fevers with cough and generalized weakness for one week. She had been evaluated by her primary care provider on day two of illness and was started empirically on cefixime without improvement of her symptoms. The patient arrived febrile, tachycardic, tachypneic, and hypoxic on room air with right-sided crackles on exam. Lung Ultrasound of the right lower lobe demonstrates lung hepatization, a classic finding for pneumonia. In addition, a shred sign is present with both air bronchograms and focal B lines-all suggestive of poorly aerated, consolidated lung. Authors critically evaluate the evidence for the use lung ultrasound for rapid diagnostic. It is important to understand this disease, rapid diagnostic with ultrasound and when treated promptly and effectively, these patients will rapidly recovery. Good oxygenation, intravenous Antibiotic, intravenous fluids and symptomatic treatment which should be started within minutes of the patients’ arrival to emergency department.

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Lung ultrasound and B-lines quantification inaccuracy: “B sure to have the right solution”. Authors’ reply

Intensive Care Medicine ◽

10.1007/s00134-020-06030-5 ◽

2020 ◽

Vol 46 (5) ◽

pp. 1084-1085

Author(s):

M. E. Haaksma ◽

J. M. Smit ◽

P. R. Tuinman

Keyword(s):

Lung Ultrasound ◽

The Right ◽

B Lines

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Prognostic value of the ultrasonic determination of the degree of interstitial edema in patients with intermediate ejection fraction of the left ventricle after treating acute decompensation of heart failure

Kardiologiia ◽

10.18087/cardio.2020.10.n923 ◽

2020 ◽

Vol 60 (10) ◽

pp. 80-85

Author(s):

E. G. Skorodumova ◽

V. A. Kostenko ◽

E. A. Skorodumova ◽

A. V. Siverina ◽

A. V. Rysev ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Lung Tissue ◽

Predictive Value ◽

Lung Ultrasound ◽

Wilcoxon Test ◽

X Ray ◽

Interstitial Component ◽

The Right ◽

B Lines

Aim To study ultrasonic characteristics of lung tissue in patients with heart failure with left ventricular (LV) mid-range ejection fraction (HFmEF) and predictive value of these characteristics after reversing acute decompensated heart failure (ADHF).Material and methods Ultrasonic characteristics of lung tissue were studied by prospective observation in 71 patients (mean age, 65.2±3.6 years; men, 64.3 %) with HFmEF (LVEF from 40 to 49 %) following ADHF reversal. Semiquantitative evaluation of B-lines was performed by the E. Picano (2016) method at 5+2 days after hospitalization and on discharge from the hospital. The distance between B-lines was 3 mm (В3 lines) and 7 mm (В7 lines). Patients’ catamnesis was studied for determining the predictive value of lung tissue ultrasonic characteristics for two years since the index hospitalization. Statistical analysis was performed using the McNemar’s χ2 test (for evaluation of linked samples and of changes in the presence/absence of B-lines as determined by lung ultrasound examination (USE)) and the Wilcoxon test (for evaluation of quantitative changes). Differences were considered significant at p<0.05.Results B7-lines characteristic of interstitial component of pulmonary parenchymal edema prevailed in patients with HFmEF. В3-lines characteristic of alveolar edema were found in a small amount. In the anterior-superior segment, B7-lines predominated over B3-lines (80 % vs. 20 %, p<0.01) on the right; however, on the lest, significant differences were not observed (64 % vs. 36 %, p>0.05). In the anterior-inferior segment, В7-lines prevailed over В3-lines on the right (75 % vs. 25 %, p<0.05); however, on the left, the difference was not significant (67 % vs. 33 %, p=0.05). In the lateral superior segment on the right, В7-lines predominated over В3-lines (75 % vs. 25 %, p<0.01); in contrast, on the left, there were no differences (67 % vs. 33 %, p>0.05). In lateral-basal segments on both sides, significant differences were present (73 % vs. 27 % on the right, p<0.05; 72 % vs. 28 % on the lest, p<0.05). The results of lung ultrasound were also used for evaluation of the B-line predictive value in patients with ADHF and mid-range EF on discharge from the hospital after reversal of X-ray and clinical symptoms of pulmonary congestion. In the next two years, 35 patients (49.2 % of sample) were rehospitalized with signs of ADHF (39 hospitalizations, 1.1 hospitalizations per patient). The rehospitalized patients were divided into two subgroups, with an increased number of B-lines and small congestion on discharge (6–15 В-lines) and without signs of congestion (<5 В-lines). For patients with a minimal (small) congestion on pulmonary ultrasound but regression of clinical and X-ray congestion, the number of rehospitalizations was 25 vs. 11 in patients with the number of B7-lines <5. In the ROC-analysis, the area under the curve was 0.706, which corresponded to the expert assessment as “good”. The position sensitivity was 78.6 % and the specificity was 79.7 %.Conclusion “Ultrasonic pulmonary edema syndrome” in patients with LV mid-range ejection fraction after reversing ADHF was characterized by predomination of the interstitial component, despite the absence of X-ray congestion, correlated with the blood level of NT-proBNP measured at the same time, and was associated with rehospitalizations.

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Advantages of lung ultrasound in triage, diagnosis and monitoring COVID-19 patients: review

Acta Marisiensis - Seria Medica ◽

10.2478/amma-2021-0019 ◽

2021 ◽

Vol 67 (2) ◽

pp. 73-76

Author(s):

Bianca Emilia Ciurba ◽

Hédi Katalin Sárközi ◽

István Adorján Szabó ◽

Nimród László ◽

Edith Simona Ianosi ◽

...

Keyword(s):

Lung Ultrasound ◽

Cost Effective ◽

Portable Devices ◽

Standard Protocol ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Pleural Line ◽

B Lines ◽

Lung Sliding ◽

Ventilated Patients

Abstract Over the last decades, especially during the COVID-19 pandemic period, lung ultrasound (LUS) gained interest due to multiple advantages: radiation-free, repeatable, cost-effective, portable devices with a bedside approach. These advantages can help clinicians in triage, in positive diagnostic, stratification of disease forms according to severity and prognosis, evaluation of mechanically ventilated patients from Intensive Care Units, as well as monitoring the progress of COVID-19 lesions, thus reducing the health care contamination. LUS should be performed by standard protocol examination. The characteristic lesions from COVID-19 pneumonia are the abolished lung sliding, presence of multiple and coalescent B-lines, disruption and thickening of pleural line with subpleural consolidations. LUS is a useful method for post-COVID-19 lesions evaluation, highlight the remaining fibrotic lesions in some patients with moderate or severe forms of pneumonia.

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Prognostic value of bedside lung ultrasound score in patients with COVID-19

10.21203/rs.3.rs-55111/v2 ◽

2020 ◽

Author(s):

Li Ji ◽

Chunyan Cao ◽

Ying Gao ◽

Wen Zhang ◽

Yuji Xie ◽

...

Keyword(s):

Prognostic Value ◽

Troponin I ◽

Lung Ultrasound ◽

Invasive Mechanical Ventilation ◽

Continuous Variable ◽

Adverse Outcomes ◽

Cox Models ◽

Pleural Line ◽

Specificity And Sensitivity ◽

B Lines

Abstract Background: Bedside lung ultrasound (LUS) has emerged as a useful and noninvasive tool to detect lung involvement and monitor changes in patients with coronavirus disease 2019 (COVID-19). However, the clinical significance of the LUS score in patients with COVID-19 remains unknown. We aimed to investigate the prognostic value of the LUS score in patients with COVID-19.Methods: The LUS protocol consisted of 12 scanning zones and was performed in 280 consecutive patients with COVID-19. The LUS score based on B-lines, lung consolidation and pleural line abnormalities was evaluated.Results: Patients in the highest LUS score group were more likely to have a lower lymphocyte percentage (LYM%); higher levels of D-dimer, C-reactive protein, hypersensitive troponin I and creatine kinase muscle-brain; more invasive mechanical ventilation therapy; higher incidence of ARDS; and higher mortality than patients in the lowest LUS score group. After a median follow-up of 14 days [IQR, 10-20 days], 37 patients developed ARDS, and 13 died. Patients with adverse outcomes presented a higher rate of bilateral involvement; more involved zones and B-lines, pleural line abnormalities and consolidation; and a higher LUS score than event-free survivors. The Cox models adding the LUS score as a continuous variable (hazard ratio [HR]: 1.05, 95% confidence intervals [CI]: 1.02～1.08; P < 0.001; Akaike Information Criterion [AIC] =272; C-index = 0.903) or as a categorical variable (HR: 10.76, 95% CI: 2.75～42.05; P = 0.001; AIC =272; C-index = 0.902) were found to predict poor outcomes more accurately than the basic model (AIC =286; C-index = 0.866). An LUS score cut-off >12 predicted adverse outcomes with a specificity and sensitivity of 90.5% and 91.9%, respectively.Conclusions: The LUS score devised by our group performs well at predicting adverse outcomes in patients with COVID-19 and is important for risk stratification in COVID-19 patients.

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Advances in lung ultrasound

Einstein (São Paulo) ◽

10.1590/s1679-45082016md3557 ◽

2016 ◽

Vol 14 (3) ◽

pp. 443-448 ◽

Cited By ~ 8

Author(s):

Miguel José Francisco Neto ◽

Antonio Rahal Junior ◽

Fabio Augusto Cardillo Vieira ◽

Paulo Savoia Dias da Silva ◽

Marcelo Buarque de Gusmão Funari

Keyword(s):

Lung Ultrasound ◽

Imaging Modality ◽

Quantitative Information ◽

Chest Ultrasonography ◽

Qualitative And Quantitative ◽

Lung Consolidation ◽

Pathological Conditions ◽

Pleural Line ◽

Sonographic Patterns ◽

B Lines

ABSTRACT Ultrasound examination of the chest has advanced in recent decades. This imaging modality is currently used to diagnose several pathological conditions and provides qualitative and quantitative information. Acoustic barriers represented by the aerated lungs and the bony framework of the chest generate well-described sonographic artifacts that can be used as diagnostic aids. The normal pleural line and A, B, C, E and Z lines (also known as false B lines) are artifacts with specific characteristics. Lung consolidation and pneumothorax sonographic patterns are also well established. Some scanning protocols have been used in patient management. The Blue, FALLS and C.A.U.S.E. protocols are examples of algorithms using artifact combinations to achieve accurate diagnoses. Combined chest ultrasonography and radiography are often sufficient to diagnose and manage lung and chest wall conditions. Chest ultrasonography is a highly valuable diagnostic tool for radiologists, emergency and intensive care physicians.

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Lung ultrasound and B-lines quantification inaccuracy: B sure to have the right solution

Intensive Care Medicine ◽

10.1007/s00134-020-06005-6 ◽

2020 ◽

Vol 46 (5) ◽

pp. 1081-1083 ◽

Cited By ~ 8

Author(s):

F. Corradi ◽

G. Via ◽

F. Forfori ◽

C. Brusasco ◽

G. Tavazzi

Keyword(s):

Lung Ultrasound ◽

The Right ◽

B Lines

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The Value of a Simplified Lung Ultrasound Protocol in the Pre-Discharge Evaluation of Patients Hospitalized with Acute Heart Failure

Acta Medica Marisiensis ◽

10.1515/amma-2016-0039 ◽

2016 ◽

Vol 62 (3) ◽

pp. 318-320

Author(s):

Frigy Attila ◽

Kocsis Ildikó ◽

Fehérvári Lajos ◽

Szabó István Adorján

Keyword(s):

Heart Failure ◽

Hospital Discharge ◽

Acute Heart Failure ◽

Lung Ultrasound ◽

Clinical Status ◽

Optimal Timing ◽

Exact Test ◽

Us Findings ◽

The Right ◽

B Lines

AbstractOptimal timing of hospital discharge in patient with acute heart failure (AHF) is an important factor of preventing rehospitalizations.Aim. To evaluate the value of a simplified lung ultrasound (LUS) protocol in assessing pre-discharge status of patients with AHF, correlating the US findings with the values of NT-proBNP levels.Methods. 24 patients (18 men, 6 women, mean age 68,2 years) hospitalized with acute heart failure underwent LUS examination in the afternoon of the day before hospital discharge, applying a simplified LUS protocol, using three basal examination areas on the right side (anterior, lateral and posterior) and two basal examination areas on the left side (lateral and posterior). The LUS score was represented by the sum of B lines. In the next morning the value of NT-proBNP was also determined. The correlation between LUS findings and NT-proBNP values was analyzed using Fisher's exact test (significant if alpha<0,05).Results. 6 patients had <15 B lines, 16 patients had >15 B lines and 2 patients had pleural effusion on LUS, while 16 patients had the value of NT-proBNP >1000pg/ml at discharge. The results of LUS examination correlated significantly (p=0.0013) with the NT-proBNP values – only one patient not having increased NT-proBNP in the group with >15 B lines.Conclusions. Despite a relatively good clinical status, the majority of patients had high NT-proBNP values at the time of hospital discharge. LUS proved to be a useful tool in identifying patients with subclinical congestion reflected also by the high NT-proBNP levels. These patients may need a prolongation of hospitalization and/or a more careful follow-up to prevent early readmission.

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