Role of Lung Ultrasound for the Etiological Diagnosis of Community- Acquired Pneumonia in Children: A Prospective Study

Abstract

Objective and design: Our prospective study is one of the largest prospective study assessing the role of detailed lung ultrasound features to discriminate the etiological diagnosis of Community acquired pneumonia (CAP) in children. Methodology: We prospectively analysed patients aged from 1 month to 17 years admitted between March 2018 and April 2020 who were hospitalized for CAP. For all patients included in the study, history, clinical parameters, microbiological data, and lung ultrasound data were collected. Patients were stratified into three main groups (bacterial, viral, atypical) according to the presumed microbial aetiology and lung ultrasound findings evaluated according to the aetiological group. Results: We found that some ultrasound findings as size, number and distribution of consolidations, the position and motion of air bronchograms, pleural effusions and distribution of vertical artifacts significantly differ (p < 0.05) in children with bacterial, viral and atypical CAP. Conversely, clinical parameters and laboratory were not able to significantly distinguish between these groups. Chest x-ray, despite being still widely used, was the less useful tool in this discrimination. Conclusion: Our study provides a detailed analysis of LUS features able to predict the etiology CAP in children. These findings may help the physicians to better manage a child with CAP and to offer personalized approach, from diagnosis to treatment and follow-up. KEYWORDS: lung ultrasound, pneumonia, CAP, etiological diagnosis, children

An algorithm combining procalcitonin and lung ultrasound improves the diagnosis of bacterial pneumonia in critically ill children: The PROLUSP study, a randomized clinical trial

“…It is important to not only accurately diagnose pneumonia, but to make a differential diagnosis between bacterial and other etiologies, to implement appropriate prevention and treatment strategies 45 . The algorithm presented in this study seems to demonstrate that it is possible to improve the accuracy for BP diagnosis when combining LUS and PCT.…”

“…The different patterns of aeration and diagnosis of pneumonia were based on previous publications 24,43–45 . BP pattern was based on the presence of lung consolidation with air bronchogram and the presence of white lung 24,46 .…”

“…The different patterns of aeration and diagnosis of pneumonia were based on previous publications. 24,[43][44][45] BP pattern was based on the presence of lung consolidation with air bronchogram and the presence of white lung. 24,46 VP pattern was based on the presence of diffuse or coalescent B lines with small, multiple, and bilateral subpleural consolidations.…”

Sono-Elastography: An Ultrasound Quantitative Non-Invasive Measurement to Guide Bacterial Pneumonia Diagnosis in Children

“…The patient bedside LUS is a widely used technique and it has been established as an essential alternative to chest X-ray for diagnosis of ALRTI. LUS has several advantages over chest X-ray, as it is faster, cheaper and does not emit radiation, so it allows the close monitoring of the evolution and the response to treatment [ 12 , 16 , 17 , 18 ]. From a physical point of view, LUS is based on the generation of variable frequency mechanical waves (2.5–20 MHz) towards the different tissues, where they are reflected, absorbed or scattered depending on the type of medium.…”

“…The different LUS patterns can be distinguished on the basis of the degree of air leakage and the presence of the different consolidation types based on previous publications [ 16 , 17 , 22 , 23 ]. BP pattern is based on the presence of lung consolidation with dynamic and branched air bronchogram within it and possible pleural line rupture ( Figure 2 a).…”