US in the Diagnosis of Pediatric Chest Diseases

Abstract

Most pediatric chest diseases are adequately evaluated with chest radiography. However, when chest radiography does not allow identification of the location and nature of an area of increased opacity, ultrasonography (US) can help establish the diagnosis. US may be helpful in evaluation of persistent or unusual areas of increased opacity in the peripheral lung, pleural abnormalities, and mediastinal widening; US is particularly useful in patients with complete opacification of a hemithorax at radiography. In cases of pulmonary parenchymal lesions, identification of air or fluid bronchograms at US and of pulmonary vessels at color flow imaging is useful for differentiating pulmonary consolidation or atelectasis from lung masses and pleural lesions. US allows characterization of pleural fluid collections as simple, complicated, or fibroadhesive, which is important information for planning thoracentesis or thoracotomy. Computed tomography and magnetic resonance imaging are superior to US in evaluation of the mediastinum, but US is a reasonable alternative in certain situations (eg, to avoid unnecessary investigation of a normal thymus simulating a mediastinal mass). In cases of chest wall lesions, US may enable localization of the site of origin to soft tissues or an extrapleural intrathoracic location. Osseous involvement, particularly rib involvement, is easily evaluated with US.

Intrathoracic Postesophagectomy Stomach

“…It can assist in differentiating between pleural, parenchymal, and mediastinal abnormalities, characterize pleural effusions, and guide aspiration or biopsy. Although the sonographic appearances of these abnormalities have been described previously, [1][2][3][4][5] to our knowledge, assessment of the postoperative pediatric thorax by sonography has not been emphasized previously. We describe the cases of 2 children after esophagectomy and gastric pull-up whose undefined opacities on chest radiography were ultimately comprehended on sonography of the abnormal hemithorax.…”

Ultrasonido de tórax en ninos

“…Si la cortical es irregular, gruesa o se interrumpe, el US lo puede demostrar 3 . El cartílago normal es hipoecogénico, con superficie regular (Figura 2).…”

“…En la celulitis podemos encontrar un aumento difuso de la ecogenicidad y colecciones líquidas, que pueden ser drenadas. La osteomielitis de la pared costal es infrecuente en niños y el US puede mostrar irregularidad o engrosamiento I. FUENTEALBA T. de la cortical del arco costal 4 , colecciones subperiósticas o colecciones adyacentes al hueso 1,3 . La TC o RM muestran mejor la extensión y el grado de compromiso infeccioso de la pared torácica.…”

“…Tumores como timoma o timolipomas son muy infrecuentes en niños, pero no así la infiltración tímica por leucemia o linfoma 3 . En estos casos el timo presenta ecogenicidad heterogénea, ecoestructura gruesa, márgenes irregulares y en algunos casos calcificaciones.…”

Imaging Findings of Chest Wall Lesions on Breast Sonography

“…Infiltration of the bone appears as a hypoechoic mass, replacing the normal echogenicity of the rib ( Figure 13). 21,22 Metastatic lesions to the soft tissue of the chest wall are uncommon. Such metastases are usually seen in patients with extensive metastases elsewhere and portend a poor prognosis.…”