The role of lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia

Reißig, Angelika; Gramegna, Andrea; Aliberti, Stefano

doi:10.1016/j.ejim.2012.01.003

Cited by 89 publications

(85 citation statements)

References 37 publications

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“…Specifically, the smaller thoracic diameter and lung volume of children and neonates permit better visualization with LUS. 26,29 Similarly, the spectrum of disease found in children may differ from that seen in the adult population, necessitating different standards in both diagnosis and treatment. 3,27 To identify pneumonia by LUS, a consolidation needs to reach the pleura and be within an intercostal window.…”

Section: Figurementioning

confidence: 99%

“…Conversely, when features typical of pneumonia are identified on LUS, it may be a result of noninfiltrative processes including atelectasis. 28,29 Atelectasis, present in common respiratory diseases such as bronchiolitis or asthma, 7,27 can present as a small consolidation and be misinterpreted as pneumonia by ultrasound. Similarly, a smaller consolidation may not be detectable by CR, which could lead to a falsenegative reading by CR.…”

Section: Figurementioning

confidence: 99%

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Lung Ultrasound for the Diagnosis of Pneumonia in Children: A Meta-analysis

et al. 2015

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BACKGROUND AND OBJECTIVE: Pneumonia is the leading cause of death of children. Diagnostic tools include chest radiography, but guidelines do not currently recommend the use of lung ultrasound (LUS) as a diagnostic method. We conducted a meta-analysis to summarize evidence on the diagnostic accuracy of LUS for childhood pneumonia. METHODS:We performed a systematic search in PubMed, Embase, the Cochrane Library, Scopus, Global Health, World Health Organization-Libraries, and Latin American and Caribbean Health Sciences Literature of studies comparing LUS diagnostic accuracy against a reference standard. We used a combination of controlled key words for age ,18 years, pneumonia, and ultrasound. We identified 1475 studies and selected 15 (1%) for further review. Eight studies (765 children) were retrieved for analysis, of which 6 (75%) were conducted in the general pediatric population and 2 (25%) in neonates. Eligible studies provided information to calculate sensitivity, specificity, and positive and negative likelihood ratios. Heterogeneity was assessed by using Q and I 2 statistics.RESULTS: Five studies (63%) reported using highly skilled sonographers. Overall methodologic quality was high, but heterogeneity was observed across studies. LUS had a sensitivity of 96% (95% confidence interval [CI]: 94%-97%) and specificity of 93% (95% CI: 90%-96%), and positive and negative likelihood ratios were 15.3 (95% CI: 6.6-35.3) and 0.06 (95% CI: 0.03-0.11), respectively. The area under the receiver operating characteristic curve was 0.98. Limitations included the following: most studies included in our analysis had a low number of patients, and the number of eligible studies was also small. Dr Pereda conceptualized and designed the study, reviewed all abstracts and selected articles to be included in the meta-analysis, was responsible for data collection, and drafted the initial manuscript; Dr Chavez conceptualized and designed the study, reviewed all abstracts and selected articles to be included in the meta-analysis, was responsible for data collection, led the analysis, and drafted the initial manuscript; Dr Hooper-Miele participated in analysis and interpretation of results, critically revised ultrasound methods used by selected studies, and reviewed and revised the manuscript; Drs Gilman, Steinhoff, Ellington, and Tielsch participated in the analysis and interpretation of results and reviewed and revised the manuscript; Ms Gross and Ms Price conducted the literature search and reviewed and revised the manuscript; Dr Checkley conceptualized and designed the study, contributed equally to the analysis, drafted the initial manuscript, and had ultimate oversight over the study conduct, analysis plan, and writing of the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.www.pediatrics.org/cgi

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Lung Ultrasound for the Diagnosis of Pneumonia in Children: A Meta-analysis

et al. 2015

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“…An anatomical analysis of lung parenchyma is only possible when the lung is completely deflated and consolidated, as occurs in atelectasis or pneumonia (lung hepatization) [9,10,11,12]. However, in the ultrasound assessment of not completely consolidated pathological lungs, as in cardiogenic or noncardiogenic pulmonary edema, the appearance of vertical artifactual phenomena has been described (B-lines or ‘white lung') and identifies the sonographic interstitial syndrome [2,4,13].…”

Section: Introductionmentioning

confidence: 99%

Lung Ultrasonography May Provide an Indirect Estimation of Lung Porosity and Airspace Geometry

Soldati¹,

Smargiassi

Inchingolo

et al. 2014

Respiration

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Background: Echographic vertical artifacts (B-lines) in chest ultrasonography have often been associated with pathological patterns. A scientifically sound explanation of these artifacts has not yet been proposed. Objectives: The ‘spongy' nature of the lung in its liquid and solid components and the changes that take place in peripheral airspace (PAS) geometry might be the key point to understanding these phenomena. Methods: Six excised right rabbit lungs were obtained. Each lung underwent direct ultrasound evaluation in two different conditions: at complete tissue elastic recoil volume and at pulmonary expansion volume achieved by applying a constant positive pressure of 12 cm H₂O. Lung volumes and densities were reported in both conditions. Histological examination was performed on three naturally collapsed lungs and on three lungs under positive pressure inflation after having been fixed in formalin solution. Results: Mean volumes of naturally collapsed lungs and fixed expanded lungs were 11.2 ± 0.36 and 44.83 ± 3.03 ml, respectively. Mean densities were 0.622 ± 0.016 and 0.155 ± 0.007 g/ml, respectively. Ultrasound evaluation of collapsed lungs showed dense vertical artifacts and a ‘white lung' pattern, while the evaluation of expanded lungs showed hyperechoic line and horizontal artifacts of reflection. Histological evaluation showed a different PAS geometry in collapsed lungs caused by alveolar size reduction and shape changes with unfolded and closed units modifying the peripheral porosity of the frothy nature of the lung. Conclusions: Airspace geometry, frothy nature and porosity are the determinants of the different behavior of ultrasound interacting with the subpleural lung parenchyma. Chest ultrasound may thus be interpreted as an indirect ‘estimator' of lung porosity.

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“…So, the use of imaging modalities is essential (20). During the last decade, diagnosis of pneumonia by chest CT has become more common, given the increasing numbers of CT scans performed to rule out other diseases such as pulmonary embolism (21). In this study, the occurrence of necrotizing pneumonia was as high as 65.5% when cases were diagnosed using chest CT (22).…”

Section: Discussionmentioning

confidence: 93%

Implementation of chest ultrasound with color Doppler in diagnosis of pneumonia in adults

Kader

Osman

2016

The Egyptian Journal of Radiology and Nuclear Medicine

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Objective: To evaluate the role of color Doppler sonography in comparison with CXR and CT imaging in diagnosis of pneumonia in adults. Patients and methods: Thirty-one patients with clinical suspicion of pneumonia were assessed by chest radiography, CT and sonography. Quantitative and qualitative sonographic examination of lesions was performed using color Doppler imaging. The correlation between color Doppler and CT findings was determined. Results: Lung ultrasound showed high sensitivity (100%), specificity (93.8%) and diagnostic accuracy 96.8% in diagnosis of pneumonia. It detected air bronchogram in all cases, simple effusion in 18 cases and effusion with internal echoes in 8 cases. It was almost agreement with CT findings (K = 0.93). The sensitivity of chest X-ray was low (60%). It was moderate agreement with CT findings (K = 0.608). A significant changes were seen in flow pattern in comparison with severity of necrosis by CT (P value = 0.038). Majority of our cases reflected pulmonary arterial flow pattern that was found in 21 cases. Conclusion: Lung ultrasound with color Doppler imaging is highly accurate and valid alternatively in diagnosis of pneumonia. By qualitative and quantitative impedance measurement, pulmonary and bronchial arteries can be differentiated. The flow pattern of pulmonary arteries was an indicative of good outcome.

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The role of lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia

Cited by 89 publications

References 37 publications

Lung Ultrasound for the Diagnosis of Pneumonia in Children: A Meta-analysis

Lung Ultrasound for the Diagnosis of Pneumonia in Children: A Meta-analysis

Lung Ultrasonography May Provide an Indirect Estimation of Lung Porosity and Airspace Geometry

Implementation of chest ultrasound with color Doppler in diagnosis of pneumonia in adults

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