Lung ultrasound characteristics of community‐acquired pneumonia in hospitalized children

Abstract

Background The diagnosis of community‐acquired pneumonia (CAP) is based mainly on the patient's medical history and physical examination. However, in severe cases a further evaluation including chest X‐ray (CXR) may be necessary. At present, lung ultrasound (LUS) is not included in the diagnostic work‐up of pneumonia. Aim To describe the ultrasonographic appearance of CAP at presentation and during the follow‐up. Methods A total of 102 patients with clinical signs and symptoms suggesting pneumonia, who underwent a clinically driven CXR, were evaluated by LUS on the same day. LUS signs of pneumonia included subpleural lung consolidation, B‐lines, pleural line abnormalities, and pleural effusion. The diagnostic gold standard was the ex‐post diagnosis of pneumonia made by two independent experienced pediatricians on the basis of clinical presentation, CXR and clinical course following British Thoracic Guidelines recommendations. Results A final diagnosis of pneumonia was confirmed in 89/102 patients. LUS was positive for the diagnosis of pneumonia in 88/89 patients, whereas CXR was positive in 81/89. Only one patient with normal LUS examination had an abnormal CXR, whereas 8 patients with normal CXR had an abnormal LUS. LUS was able to detect pleural effusion resulting from complicated pneumonia in 16 cases, whereas CXR detected pleural effusion in 3 cases. Conclusions LUS is a simple and reliable imaging tool, not inferior to CXR in identifying pleuro‐pulmonary alterations in children with suspected pneumonia. During the course of the disease, LUS allows a radiation‐free follow‐up of these abnormalities. Pediatr Pulmonol. 2013; 48:280–287.