Lung ultrasound for the diagnosis of community-acquired pneumonia in children

Abstract

Ultrasound (US) has been proposed as an alternative first-line imaging modality to diagnose community-acquired pneumonia in children. Lung US has the potential benefits over chest radiography of being radiation free, subject to fewer regulatory requirements, relatively lower cost and with immediate bedside availability of results. However, the uptake of lung US into clinical practice has been slow and it is not yet included in clinical guidelines for community-acquired pneumonia in children. The aim of this review is to give an overview of the equipment and techniques used to perform lung US in children with suspected pneumonia and the interpretation of relevant sonographic findings. We also summarise the current evidence of diagnostic accuracy and reliability of lung US compared to alternative imaging modalities in children and critically consider the strengths and limitations of lung US for use in children presenting with suspected community-acquired pneumonia.

Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta‐analysis

“…However, this study bears several limitations that merit consideration. First, LUS does not reliably differentiate pneumonia from other conditions that also present with lung hepatization, such as atelectasis or pulmonary edema . That may lead to a higher false‐positive rate and therefore a lower specificity.…”

The Use of Lung Ultrasound to Monitor the Antibiotic Response of Community‐Acquired Pneumonia in Children: A Preliminary Hypothesis

“…For these reasons, lung US can easily be used not only for the diagnosis of CAP but also for monitoring of the response to therapy, as suggested by recent research . Nevertheless, the most of the published studies on this topic focused mainly on the accuracy of lung US in comparison with chest radiography in recognizing lung consolidations and bronchograms, without providing US details of the consolidations, such as the bronchogram position, morphologic characteristics, and dynamicity . Moreover, those studies including follow‐up lung US during CAP treatment did not include a detailed diagnostic lung US examination (done at time of diagnosis) and did not describe early lung US changes during the treatment in a detailed way …”

“…5 Nevertheless, the most of the published studies on this topic focused mainly on the accuracy of lung US in comparison with chest radiography in recognizing lung consolidations and bronchograms, without providing US details of the consolidations, such as the bronchogram position, morphologic characteristics, and dynamicity. [6][7][8][9] Moreover, those studies including follow-up lung US during CAP treatment did not include a detailed diagnostic lung US examination (done at time of diagnosis) and did not describe early lung US changes during the treatment in a detailed way. [10][11][12] In the following case series, we describe clinical and laboratory results as well as detailed lung US findings of 6 children with CAP, at baseline and 48 hours after beginning antibiotic treatment, showing the potential use of lung US in monitoring the response to antibiotic therapy.…”

Acute Bronchiolitis: Is There a Role for Lung Ultrasound?

“…In the last decades, Lung Ultrasound (LUS) has been proposed as a diagnostic tool in many diseases in the pediatric and neonatological settings [3][4][5]. In particular, the anatomical conformation of children makes the sonographic evaluation of the lungs possible for the creation of acoustic windows by the relatively unossified thorax of children, the large thymus gland and the thinner subcutaneous tissue [6].…”