First-line diagnosis of paediatric pneumonia in emergency: lung ultrasound (LUS) in addition to chest-X-ray (CXR) and its role in follow-up
First-line diagnosis of paediatric pneumonia in emergency: lung ultrasound (LUS) in addition to chest-X-ray (CXR) and its role in follow-up
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DOI：
10.1259/bjr.20150998
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发表时间：
2016-01-01
影响因子：
2.6
通讯作者：
Miele, Vittorio
中科院分区：
文献类型：
--
作者：
Ianniello, Stefania;Piccolo, Claudia Lucia;Miele, Vittorio
目的：肺部超声（LUS）与胸部X线检查（CXR）的作用集成为儿科肺炎的一线诊断，以确定其作用在后续排除complications.Methods：我们进行了一项回顾性研究的队列，包括84个连续的儿童（年龄范围：3-16岁;平均年龄：6岁; 44名男性，40名女性）的咳嗽和发热的临床体征。所有患者均在入院时接受CXR检查并结合LUS检查。结果：84例患者中，CXR检查发现47例肺部病变。LUS显示60/84例肺部结果; 34/60例肺部结果具有典型的肺实变模式; 26/60例肺部结果显示多条B线相关，结果与间质受累一致，以及CXR无法实现的小而隐藏的实变。1例因肩胛后位置LUS阴性。60例患者进行LUS随访，28/60例患者显示疾病完全消退，23/60例患者的实变大小显著减小，9/60例患者显示疾病稳定或大小不显著减小，因此需要进行连续LUS检查。LUS与CXR相结合，显示是识别小的肺部实变的准确的一线技术，特别是对于“CXR隐匿性”结果，和胸腔积液的早期诊断;此外，LUS后续允许并发症进行验证和额外的辐射exposure to be avoided.Advances in knowledge：The effective role of LUS in the diagnosis and following of lung consolidations and pleural effusions in pediatric patients in an emergency setting.
Objective: The role of lung ultrasound (LUS) integrated with chest X-ray (CXR) for the first-line diagnosis of paediatric pneumonia; to define its role during the follow-up to exclude complications.Methods: We performed a retrospective review of a cohort including 84 consecutive children (age range: 3-16 years; mean age: 6 years; 44 males, 40 females) with clinical signs of cough and fever. All the patients underwent CXR at admission integrated with LUS. Those positive at LUS were followed up with LUS until the complete resolution of the disease.Results: CXR showed 47/84 pneumonic findings. LUS showed 60/84 pneumonic findings; 34/60 pneumonic findings had a typical pattern of lung consolidation; 26/60 pneumonic findings showed association of multiple B-lines, findings consistent with interstitial involvement, and small and hidden consolidations not achievable by CXR. One case was negative at LUS because of retroscapular location. 60 patients were followed up with LUS; 28/60 patients showed a complete regression of the disease; 23/60 patients had a significant decrease in size of consolidation; 9/60 patients showed disease stability or insignificant decrease in size, thus requiring adjunctive LUS examinations.Conclusion: LUS, integrated with CXR, revealed to be an accurate first-line technique to identify small pneumonic consolidations, especially for "CXR-occult" findings, and for early diagnosis of pleural effusion; furthermore, LUS follow-up allows complications to be verified and additional radiation exposures to be avoided.Advances in knowledge: The effective role of LUS in the diagnosis and follow-up of lung consolidations and pleural effusions in paediatric patients in an emergency setting.