BackgroundClinical assessment is the gold standard for diagnosis of bronchiolitis. To date, only one study found LUS (Lung Ultrasound) to be a valuable tool in the diagnosis of bronchiolitis. Aim of this study is to evaluate the accuracy of lung ultrasonography in the diagnosis and management of bronchiolitis in infants.MethodsThis was an observational cohort study of infants admitted to our Pediatric Unit with suspected bronchiolitis. A physical examination and lung ultrasound scans were performed on each patient. Diagnosis and grading of bronchiolitis was assessed according to a clinical and a ultrasound score. An exploratory analysis was used to assess correspondence between the lung ultrasound findings and the clinical evaluation and to evaluate the inter-observer concordance between the two different sonographs.ResultsOne hundred six infants were studied (average age 71 days). According to our clinical score, 74 infants had mild bronchiolitis, 30 had moderate bronchiolitis and two had severe bronchiolitis. 25 infants composed the control group. Agreement between the clinical and sonographic diagnosis was good (90.6 %) with a statistically significant inter-observer ultrasound diagnosis concordance (89.6 %).Lung ultrasound permits the identification of infants who are in need of supplementary oxygen with a specificity of 98.7 %, a sensitivity of 96.6 %, a positive predictive value of 96.6 % and a negative predictive value of 98.7 %. An aberrant ultrasound lung pattern in posterior chest area was collected in 86 % of infants with bronchiolitis. In all patients clinical improvement at discharge was associated with disappearance of the previous LUS findings. Subpleural lung consolidation of 1 cm or more in the posterior area scan and a quantitative classification of interstitial syndrome based on intercostal spaces involved bilaterally, good correlate with bronchiolitis severity and oxygen use.ConclusionsThe lung ultrasound findings strictly correlate with the clinical evaluations in infants with bronchiolitis and permit the identification of infants who are in need of supplementary oxygen with high specificity. Scans of the posterior area are more indicative in ascertaining the severity of bronchiolitis.Trial registrationClinical Trial Registration NCT01993797

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Background: Pediatric bronchopneumonia represents a clinical challenge, especially when it comes to the identification of its etiology. Study design: We performed a retrospective study on 100 patients admitted to our pediatric department. Only patients with bronchopneumonic consolidations were selected, discharged with a diagnosis of Community-Acquired Pneumonia (CAP) or bronchopneumonia. The purpose of our study was to identify Mycoplasma pneumonia based on lung ultrasound (LUS) findings. Methodology: At least two lung LUS were performed on each patient: on admission and few days after start of therapy, with some patients undergoing a third ultrasound evaluation approximately one week after discharge. These reports were collected for each patient together with clinical and laboratory data. The study population was divided into two groups: patients who tested positive for Mycoplasma pneumoniae (Myc-CAP) and negative ones (non-Myc-CAP). All patients performed serological test for determination of anti-mycoplasma antibodies, and in doubtful cases also molecular test with PCR on pharyngeal exudate. Results: The results obtained after statistical analysis showed no significant differences in LUS findings between the two groups, that could allow a positive differential diagnosis of Myc-CAP without resorting to laboratory testing. Conclusions: LUS undoubtedly represents a valid and irreplaceable help in the morphological study of pulmonary lesions over the course of disease from the time of admission to follow-up.

Background Pediatric bronchopneumonia represents a clinical challenge, especially when it comes to the identification of its etiology. We performed a retrospective study on 100 patients admitted to our pediatric department. Only patients with bronchopneumonic thickening were selected, discharged with a diagnosis of Community - Acquired Pneumonia (CAP) or bronchopneumonia. The purpose of our study was to identify Mycoplasma pneumonia based on lung ultrasound (LUS) findings. Methods At least two lung LUS were performed on each patient: on admission and few days after start of therapy, with some patients undergoing a third ultrasound evaluation approximately one week after discharge. These reports were collected for each patient together with clinical and laboratory data. The study population was divided into two groups: patients who tested positive for Mycoplasma pneumoniae (Myc-CAP) and negative ones (non-Myc-CAP). All patients performed serological test for determination of anti-mycoplasma antibodies, and in doubtful cases also molecular test with PCR on pharyngeal exudate. Results The results obtained after statistical analysis showed no significant differences in LUS findings between the two groups, that could allow a positive differential diagnosis of Myc-CAP without resorting to laboratory testing. Conclusions LUS undoubtedly represents a valid and irreplaceable help in the morphological study of pulmonary lesions over the course of disease from the time of admission to follow-up.

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