Usefulness of Lung Ultrasound in Paediatric Respiratory Diseases

Respiratory infection diseases are among the major causes of morbidity and mortality in children. Diagnosis is focused on clinical presentation, yet signs and symptoms are not specific and there is a need for new non-radiating diagnostic tools. Among these, lung ultrasound (LUS) has recently been included in point-of-care protocols showing interesting results. In comparison to other imaging techniques, such as chest X-ray and computed tomography, ultrasonography does not use ionizing radiations. Therefore, it is particularly suitable for clinical follow-up of paediatric patients. LUS requires only 5–10 min and allows physicians to make quick decisions about the patient’s management. Nowadays, LUS has become an early diagnostic tool to detect pneumonia during the COVID-19 pandemic. In this narrative review, we show the most recent scientific literature about advantages and limits of LUS performance in children. Furthermore, we discuss the major paediatric indications separately, with a paragraph fully dedicated to COVID-19. Finally, we mention potential future perspectives about LUS application in paediatric respiratory diseases.

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COVID-19 Assessment with Bedside Lung Ultrasound in a Population of Intensive Care Patients Treated with Mechanical Ventilation and ECMO

Diagnostics ◽

10.3390/diagnostics10070447 ◽

2020 ◽

Vol 10 (7) ◽

pp. 447 ◽

Cited By ~ 5

Author(s):

Hasse Møller-Sørensen ◽

Jakob Gjedsted ◽

Vibeke Lind Jørgensen ◽

Kristoffer Lindskov Hansen

Keyword(s):

Intensive Care ◽

Lung Ultrasound ◽

Imaging Modality ◽

Point Of Care ◽

X Ray ◽

Intensive Care Patients ◽

Reactive Protein ◽

Extracorporal Membrane Oxygenation ◽

Accessible Point ◽

Chest X Ray

The COVID-19 pandemic has increased the need for an accessible, point-of-care and accurate imaging modality for pulmonary assessment. COVID-19 pneumonia is mainly monitored with chest X-ray, however, lung ultrasound (LUS) is an emerging tool for pulmonary evaluation. In this study, patients with verified COVID-19 disease hospitalized at the intensive care unit and treated with ventilator and extracorporal membrane oxygenation (ECMO) were evaluated with LUS for pulmonary changes. LUS findings were compared to C-reactive protein (CRP) and ventilator settings. Ten patients were included and scanned the day after initiation of ECMO and thereafter every second day until, if possible, weaned from ECMO. In total 38 scans adding up to 228 cineloops were recorded and analyzed off-line with the use of a constructed LUS score. The study indicated that patients with a trend of lower LUS scores over time were capable of being weaned from ECMO. LUS score was associated to CRP (R = 0.34; p < 0.03) and compliance (R = 0.60; p < 0.0001), with the strongest correlation to compliance. LUS may be used as a primary imaging modality for pulmonary assessment reducing the use of chest X-ray in COVID-19 patients treated with ventilator and ECMO.

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Effectiveness of Lung Ultrasound in Comparison with Chest X-Ray in Diagnosis of Lung Consolidation

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.669 ◽

2019 ◽

Vol 7 (15) ◽

pp. 2457-2461

Author(s):

Youssef Ibrahim Haggag ◽

Karim Mashhour ◽

Kamal Ahmed ◽

Nael Samir ◽

Waheed Radwan

Keyword(s):

Lung Ultrasound ◽

Community Acquired Pneumonia ◽

P Value ◽

Initial Examination ◽

X Ray ◽

Chest Ultrasound ◽

Lung Consolidation ◽

Plain Chest ◽

Chest X Ray

BACKGROUND: Lung ultrasound (US) is an available and inexpensive tool for the diagnosis of community-acquired pneumonia (CAP); it which has no hazards of radiation and can be easily used. AIM: To evaluate the efficacy of lung ultrasound in the diagnosis and follow-up of CAP. PATIENTS AND METHODS: 100 patients aged from 40 to 63 years with a mean age of 52.3 ± 10 years admitted to the Critical Care Department, Cairo University with pictures of CAP. Lung US was performed for all patients initially, then a plain chest X-ray (CXR) was performed. Another lung ultrasound was performed on the 10th day after admission. RESULTS: Initial chest X-ray was correlated with the initial chest ultrasound examination in CAP diagnosis (R-value = 0.629, P < 0.001). Cohen's κ was run to determine if there is an agreement between the findings of the initial chest X-ray findings and those of the initial chest ultrasound in CAP diagnosis. A moderate agreement was found where κ = .567 (95% CI, 0.422 to 0.712) and P < 0.001. Upon initial examination, the CXR diagnosed CAP in 48.0% of patients, while lung US diagnosed the disease in 70% of patients. Moreover, lung US was more sensitive than CXR (P-value < 0.001). Compared to the accuracy of computed tomography (CT) chest (100%) which is the gold standard for CAP diagnosis, the accuracy of lung US was 95.0%, while the accuracy of CXR was 81.0%. CONCLUSION: This study proved the effectiveness of lung ultrasound in CAP diagnosis.

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Lung Ultrasound as a New Technique for Diagnosis of Neonatal Respiratory Diseases

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.37.4.224 ◽

2018 ◽

Vol 37 (4) ◽

pp. 224-232 ◽

Cited By ~ 1

Author(s):

Yasser N. Elsayed

Keyword(s):

Lung Disease ◽

Lung Ultrasound ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Ultrasound Images ◽

X Ray ◽

The Past ◽

Neonatal Lung ◽

Chest X Ray ◽

A New Technique

Point-of-care ultrasound in the NICU is becoming more commonplace and is now used for a number of indications. Over the past ten years, the use of ultrasound as an alternative to a chest x-ray for the diagnosis of neonatal lung disease has been explored, and protocols were developed to refine the interpretation of ultrasound images in neonatal lung disease. The purpose of this column is to briefly explain the physics of ultrasound and describe the application of ultrasound to neonatal lung assessment.

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Point-of-care diagnosis of perioperative lung pathology with lung ultrasound in cardiothoracic surgery - comparison with clinical examination and chest x-ray

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2017.02.119 ◽

2017 ◽

Vol 31 ◽

pp. S44-S45

Author(s):

David Canty ◽

J Ford ◽

J Heiberg ◽

A Brennan ◽

C Royse ◽

...

Keyword(s):

Clinical Examination ◽

Lung Ultrasound ◽

Point Of Care ◽

Cardiothoracic Surgery ◽

Lung Pathology ◽

X Ray ◽

Chest X Ray

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Lung ultrasound assessment of acute respiratory distress syndrome caused by coronavirus disease 2019: An observational study

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920969326 ◽

2020 ◽

pp. 102490792096932

Author(s):

Ruiting Li ◽

Hong Liu ◽

Hong Qi ◽

Yin Yuan ◽

Xiaojing Zou ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Observational Study ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Lung Ultrasound ◽

Point Of Care ◽

Characteristic Analysis ◽

X Ray ◽

Chest X Ray

Background: An outbreak of coronavirus disease 2019 (COVID-19) took place in Wuhan, China, by the end of 2019, and the disease continues to spread all over the world. The number of patients is increasing rapidly, a large number of infected patients is critically ill, and the mortality is high. However, information on COVID-19 patients is limited, and its clinical characteristics have not been fully studied. Objectives: To compare the performances of point-of-care lung ultrasound (LUS) and bedside chest X-ray in assessing the condition of COVID-19 patients with acute respiratory distress syndrome (ARDS). Methods: This observational study enrolled 42 COVID-19 patients with ARDS who were admitted to the Department of Critical Care Medicine of the Wuhan Union Hospital from February to April 2020. The point-of-care LUS characteristics of the COVID-19 patients with ARDS were summarized, and the performances of LUS and bedside chest X-ray in assessing the patient’s condition were compared. Results: Most of the 42 patients were elderly individuals with chronic clinical diseases. The proportion of patients older than 60 years old was 85.7%. All patients were given invasive mechanical ventilation; eight (19.0%) of them received venovenous extracorporeal membrane oxygenation support. LUS has evident advantages in detecting lung consolidation, patchy shadows, and pleural thickening, and pleural line changes in particular. The receiver operating characteristic analysis indicated that the sensitivity, Youden index, and kappa value for detecting COVID-19 patients with ARDS were higher for LUS than the chest X-ray. Conclusion: LUS has better diagnostic accuracy and sensitivity in COVID-19 patients with ARDS than the chest X-ray.

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The potential application of dual-energy subtraction radiography for COVID-19 pneumonia imaging

British Journal of Radiology ◽

10.1259/bjr.20201384 ◽

2021 ◽

pp. 20201384

Author(s):

Brent van der Heyden

Keyword(s):

Soft Tissues ◽

Imaging Techniques ◽

Dual Energy ◽

X Ray ◽

X Ray Imaging ◽

Imaging Application ◽

Chest X Ray ◽

Energy Subtraction ◽

Potential Use

X-ray imaging plays a crucial role in the confirmation of COVID-19 pneumonia. Chest X-ray radiography and CT are two major imaging techniques that are currently adopted in the diagnosis of COVID-19 pneumonia. However, dual-energy subtraction radiography is hardly discussed as potential COVID-19 imaging application. More advanced X-ray radiography equipment often supports dual-energy subtraction X-ray radiography. Dual-energy subtraction radiography enables the calculation of pseudo-radiographs, in which bones are removed and only soft-tissues are highlighted. In this commentary, the author would like to draw the attention to the potential use of dual-energy subtraction X-ray radiography (i.e. soft-tissue pseudo-radiography) for the assessment and the longitudinal follow-up of COVID-19 pneumonia.

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Comparison of Lung Ultrasound versus Chest X-ray for Detection of Pulmonary Infiltrates in COVID-19

Diagnostics ◽

10.3390/diagnostics11020373 ◽

2021 ◽

Vol 11 (2) ◽

pp. 373

Author(s):

María Mateos González ◽

Gonzalo García de Casasola Sánchez ◽

Francisco Javier Teigell Muñoz ◽

Kevin Proud ◽

Davide Lourdo ◽

...

Keyword(s):

Prospective Observational Study ◽

Lung Ultrasound ◽

Point Of Care ◽

Kappa Statistic ◽

Attractive Alternative ◽

X Ray ◽

Pulmonary Infiltrates ◽

Chest X Ray ◽

Polymerase Chain ◽

B Lines

Point-of-care lung ultrasound (LUS) is an attractive alternative to chest X-ray (CXR), but its diagnostic accuracy compared to CXR has not been well studied in coronavirus disease 2019 (COVID-19) patients. We conducted a prospective observational study to assess the correlation between LUS and CXR findings in COVID-19 patients. Ninety-six patients with a clinical diagnosis of COVID-19 underwent an LUS exam and CXR upon presentation. Physicians blinded to the CXR findings performed all LUS exams. Detection of pulmonary infiltrates by CXR versus LUS was compared between patients categorized as suspected or confirmed COVID-19 based on reverse transcriptase-polymerase chain reaction. Sensitivities and correlation by Kappa statistic were calculated between LUS and CXR. LUS detected pulmonary infiltrates more often than CXR in both suspected and confirmed COVID-19 subjects. The most common LUS abnormalities were discrete B-lines, confluent B-lines, and small subpleural consolidations. Most important, LUS detected unilateral or bilateral pulmonary infiltrates in 55% of subjects with a normal CXR. Substantial agreement was demonstrated between LUS and CXR for normal, unilateral or bilateral findings (Κ = 0.48 (95% CI 0.34 to 0.63)). In patients with suspected or confirmed COVID-19, LUS detected pulmonary infiltrates more often than CXR, including more than half of the patients with a normal CXR.

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Implementing Lung Ultrasound in the Outpatient Management of COVID-19 Pneumonia: A Pilot Study to Update Local Guidelines

Frontiers in Medicine ◽

10.3389/fmed.2021.774035 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chloé Chevallier Lugon ◽

Aileen Kharat ◽

Paola M. Soccal ◽

Idris Guessous ◽

Hervé Spechbach ◽

...

Keyword(s):

Systematic Approach ◽

Lung Ultrasound ◽

High Sensitivity ◽

Descriptive Statistics ◽

X Rays ◽

Single Center ◽

X Ray ◽

Ambulatory Patients ◽

Chest X Ray

Background: Lung ultrasound (LUS) has a good performance with a high sensitivity and specificity for the diagnosis of pneumonia compared with chest X-ray, and it has been extensively used to assess patients during the COVID-19 pandemic. This study aims to evaluate the potential advantages of the regular use of LUS for the assessment of the severity and prognosis of COVID-19 pneumonia and to propose an adapted protocol with its inclusion in current local validated and published guidelines.Methods: This is a single-center prospective study conducted during the first (April–May 2020) and second (October 2020–January 2021) waves of the SARS-CoV2 pandemic in Switzerland. All adult patients presenting to dedicated test centers with a suspicion of mild-to-moderate COVID-19 pneumonia and not requiring hospitalization at the time of diagnosis were included. Patients with confirmed COVID-19 pneumonia were referred to an ambulatory follow-up unit at our institution for reassessment, with the inclusion of the use of LUS in a random selection. Descriptive statistics were calculated for demographics using percentages, means, and standard deviations according to the distribution of variables.Results: Eighty-eight ambulatory patients with a confirmed COVID-19 pneumonia were included (men = 57 [59%]; mean age, 52.1 ± 13.5 years). Among these, 19 (21%) were hospitalized and none died. Twenty-five lung assessments by ultrasound were performed during the follow-up consultation. All were consistent with the clinical examination and confirmed the clinician's opinion.Conclusion: The use of a standardized pleuro-pulmonary ultrasound protocol for ambulatory patients with COVID-19 could help to reduce the use of chest X-rays and improve overall management at the time of referral and eventual follow-up. However, a specific study including LUS in a systematic approach should be performed to evaluate the outcome of patients according to findings.

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Role of Lung Ultrasound in the Diagnosis of Neonatal Respiratory Disorders

QJM ◽

10.1093/qjmed/hcab113.055 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Nehal M El Raggal ◽

laila A Hegazy ◽

Hossam M Sakr ◽

Yasmin A Farid ◽

Osama A Eldafrawy ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Lung Ultrasound ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Cross Sectional ◽

X Ray ◽

Chest X Ray

Abstract lung ultrasound (LUS) was used traditionally in the assessment of pleural effusions and masses but LUS has moved towards the imaging of the pulmonary parenchyma, mainly as a point-of-care technique. Objective To assess the agreement between LUS and CXR for the diagnosis of RD in neonates. Methods This prospective cross sectional study was conducted on 100 neonates presents with RD in the first 24 hours of life in the neonatal intensive care unit (NICU) of the Ain Shams University. All enrolled neonates underwent LUS and CXR initially and on day 7. Neonatologists were blind to the LUS diagnosis and the clinical decisions were driven by CXR findings. Lung score was applied to describe lung aeration, interstitial, alveolar, or consolidation patterns for each lung area. Results 125 different diagnoses were reported in 100 patients. The total agreement between LUS and CXR diagnosis was 96% (95% CI 88–98%) with a κ statistic of 0.94 (95% CI 0.86– 1.00). The agreement for RDS, Pneumonia, TTN, MAS, CDH, PE, Pnumothorax and atelectasis were 99%, 96%,98%, 99%,100%,100%,98% and 98% consequently. Conclusion LUS is a safe, low coast, easy to operate and has high agreement with CXR for the diagnosis of RD in neonates in the first week of life. Key words Neonatal intensive care, Point-of-care ultrasound, Chest X-ray Abbreviations: NICU: Neonatal Intensive Care Unit, LUS: Lung ultrasound, CXR: Chest X ray, RDS: respiratory distress syndrome, TTN: Transient Tachypnea of Newborn, MAS: Meconium Aspiration, PE: pleural effusion, CDH: cong. diaphragmatic hernia.

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