Lung ultrasound: A useful additional tool in clinician's hands to identify pulmonary atelectasis in children with neuromuscular disease

Abstract

Introduction and ObjectivesPatients with neuromuscular disease (NMD) are often exposed to ionizing radiations which could be reduced if a noninvasive and reliable diagnostic method is identified. The major aim of this study was to compare the use of chest X‐ray (CXR) with lung ultrasound (LUS) in pediatric patients with NMD, to identify pulmonary atelectasis (PA).Materials and MethodsA prospective study was conducted on children affected by NMD. In all patients who underwent CXR, a LUS was also performed and results compared for the assessment of PA.ResultsForty children affected by NMD were enrolled. Spinal muscular atrophy type 1 was the most common NMD, followed by spinal muscular atrophy type 2 and congenital myopathies. More than half of the subjects presented PA, more prevalent in the lung left lower lobes. LUS agreed with CXR results (negative or positive for atelectasis) in 31 patients (77.5%). In two patients, an agreement evaluation was not possible due to non‐conclusive LUS. Conversely, LUS disagreed with CXR in seven patients, four of which were positive for atelectasis. If only complete agreement was considered, the statistical analysis between CXR and LUS showed: LUS sensitivity of 57%, LUS specificity of 82%, positive predictive value 80%, negative predictive value 61%.ConclusionsThis study suggests that the use of LUS should be recommended to early identify PA and reduce frequent ionizing exposition of these fragile patients. Finally, our study also suggests that LUS can provide relevant information for clinicians and respiratory physiotherapists.

Effect of different oxygen concentrations developing pulmonary atelectasis of neonates during anesthesia: a randomized controlled trial

“…Ultrasound has unique advantages in the diagnosis of pulmonary atelectasis, and has become an important tool for the diagnosis of pulmonary atelectasis because of its convenience, noninvasiveness, high accuracy, and lack of radiation damage. It is also possible to visualize, in real time and in a dynamic state [20]. The resuscitation maneuver reverses the atelectasis and significantly improves pulmonary gas exchange.…”

Could It Be Pneumonia? Lung Ultrasound in Children With Low Clinical Suspicion for Pneumonia

“…A study of 40 children with neuromuscular disease showed an excellent agreement between atelectasis on POCUS by either a radiologist or pediatrician with experience in this modality and CXR as interpreted by a radiologist, with the qualification that clinical correlation is required in the not infrequent case of an inconclusive result. 27 A study of 80 intubated neonates in intensive care, using expanded criteria for the sonographic diagnosis of atelectasis, showed a higher sensitivity for atelectasis on lung ultrasound than on CXR, using CT as a gold standard when CXR was normal. 28 Last, a study of 15 pediatric patients anesthetized for MRI showed 88% accuracy when comparing lung ultrasound for atelectasis with MRI, with high interrater reliability for both modalities.…”

Usefulness of Lung Ultrasound in Paediatric Respiratory Diseases

“…In addition, LUS had a better inter-reader agreement for all the mentioned signs [62]. Other diseases that showed non-specific LUS findings are sickle cell disease [64], scoliosis [65], anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) [66], acute asthma [67], interstitial lung diseases [68], neuromuscular diseases [69] and cystic fibrosis [70,71]. A case series of four patients with severe scoliosis showed that LUS could be useful to detect lung consolidation in these patients when CXR is hampered by costal deviations [65].…”