Lung ultrasound for the diagnosis of community-acquired pneumonia in children

Pediatric Radiology, Sep 2017

Ultrasound (US) has been proposed as an alternative first-line imaging modality to diagnose community-acquired pneumonia in children. Lung US has the potential benefits over chest radiography of being radiation free, subject to fewer regulatory requirements, relatively lower cost and with immediate bedside availability of results. However, the uptake of lung US into clinical practice has been slow and it is not yet included in clinical guidelines for community-acquired pneumonia in children. The aim of this review is to give an overview of the equipment and techniques used to perform lung US in children with suspected pneumonia and the interpretation of relevant sonographic findings. We also summarise the current evidence of diagnostic accuracy and reliability of lung US compared to alternative imaging modalities in children and critically consider the strengths and limitations of lung US for use in children presenting with suspected community-acquired pneumonia.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs00247-017-3910-1.pdf

Lung ultrasound for the diagnosis of community-acquired pneumonia in children

Pediatr Radiol Lung ultrasound for the diagnosis of community-acquired pneumonia in children Jacob A. M. Stadler 0 1 2 4 5 Savvas Andronikou 0 1 2 4 5 Heather J. Zar 0 1 2 4 5 0 Department of Radiology, University of Cape Town , Cape Town , South Africa 1 University of Bristol , Bristol , UK 2 Department of Paediatric Radiology, Bristol Royal Hospital for Children , Upper Maudlin Street, Bristol BS2 8BJ , UK 3 Savvas Andronikou 4 MRC Unit on Child and Adolescent Health, University of Cape Town , Cape Town , South Africa 5 Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital , Cape Town , South Africa Ultrasound (US) has been proposed as an alternative first-line imaging modality to diagnose communityacquired pneumonia in children. Lung US has the potential benefits over chest radiography of being radiation free, subject to fewer regulatory requirements, relatively lower cost and with immediate bedside availability of results. However, the uptake of lung US into clinical practice has been slow and it is not yet included in clinical guidelines for community-acquired pneumonia in children. The aim of this review is to give an overview of the equipment and techniques used to perform lung US in children with suspected pneumonia and the interpretation of relevant sonographic findings. We also summarise the current evidence of diagnostic accuracy and reliability of lung US compared to alternative imaging modalities in children and critically consider the strengths and limitations of lung US for use in children presenting with suspected community-acquired pneumonia. Children; Community-acquired pneumonia; Lung; Pneumonia; Ultrasound - Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa Introduction Pneumonia remains the leading cause of death in children outside the neonatal period, but confirmation of a clinically suspected diagnosis, either to guide management or for consistent case definition in epidemiological and vaccine studies, remains problematic. Chest radiography is generally considered the first-line standard-of-care imaging modality to investigate suspected pneumonia, with alveolar consolidation or interstitial infiltrates combined with high serum C-reactive protein considered diagnostic for bacterial pneumonia. However, chest radiography cannot be considered a diagnostic gold standard due to wide inter- and intraobserver variability when interpreting results, differing radiologic manifestations of pneumonia and possible lack of sensitivity and specificity [ 1–7 ]. Due to the potentially harmful effects of radiation exposure, some clinical guidelines advise against the routine use of chest radiography in uncomplicated acute lower respiratory infections in childhood populations with high vaccination cover for Haemophilus influenzae type B and Pneumococcus [ 8, 9 ]. The use of chest radiography is further limited by the cost and expertise required for operating a radiology service. Historically, ultrasound (US) has played a relatively minor role in pneumonia diagnosis, being viewed mostly as a complementary tool to standard radiography in complicated disease. More recently, decreased cost and increased availability of portable US technology as well as its potential to decrease radiation exposure has renewed interest in the use of lung US as a first-line imaging modality for the diagnosis of pneumonia, especially in children. Methods initially used in adult studies were adapted for use in children and feasibility, diagnostic accuracy and reliability have now been assessed in children in multiple settings. As the use of US is not subject to the same regulatory requirements as radiography and the cost of basic US technology is considerably lower than operating a basic radiology service, it has the potential to expand access to diagnostic imaging in low resource settings and could lead to overall cost savings. Clinician-driven use with immediate availability of results is another reason US may be favoured in certain settings. This article aims to describe the technique and sonographic findings used for US diagnosis of community-acquired pneumonia in children and summarise current evidence of its diagnostic accuracy and reliability. Technique and equipment The type and size of the transducer depends on the age and size of the child. For an intercostal approach, small linear or micro-convex probes are preferred. In lung US, where the pleura and subpleural space are being assessed, a highfrequency transducer (5-15 MHz) is appropriate. Children can be scanned in the upright, supine or decubitus position. Scanning an uncooperative child can be challenging but is usually feasible. One approach is to scan the child while he is seated on a caregiver’s lap (even while breastfeeding) to minimise anxiety. To improve control of the probe, the base of the operator’s hand can be stabilized against the chest wall. This minimises movemen (...truncated)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs00247-017-3910-1.pdf

Jacob A. M. Stadler, Savvas Andronikou, Heather J. Zar. Lung ultrasound for the diagnosis of community-acquired pneumonia in children, Pediatric Radiology, 2017, pp. 1412-1419, Volume 47, Issue 11, DOI: 10.1007/s00247-017-3910-1