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Correspondence |

Diagnosis of Pneumonia by Lung Ultrasound in Children and Limited Resources Subsets: A Valuable Medical Breakthrough FREE TO VIEW

Francesca M. Trovato, MD; Daniela Catalano, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aDepartment of Clinical and Experimental Medicine, The University Hospital of Catania, Catania, Italy

bAccident and Emergency Department, Ospedale Civile, Ragusa, Italy

cPostgraduate School of Clinical Ultrasound, University of Catania, Catania, Italy

CORRESPONDENCE TO: Francesca M. Trovato, MD, Department of Clinical and Experimental Medicine, The University Hospital of Catania, via Santa Sofia 79-95123, Catania, Italy


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(1):258-260. doi:10.1016/j.chest.2016.04.032
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We read with a great interest the article in this issue of CHEST reporting the elegant and essential randomized controlled trial by Jones et al, which challenges the “Feasibility and Safety of Substituting Lung Ultrasonography for Chest Radiography When Diagnosing Pneumonia in Children” by a clinical risk management approach. This contribution is particularly relevant because lung ultrasound (LUS) is an established, shared current practice. We would respectfully add few comments. Limited resources subsets call appropriately for the dissemination and use of LUS (ie, small point-of-care hospitals or clinics; situations with serious time constraints, such as in many emergency units; either mobile or primary first aid rooms; sport or occupational medicine clinics, and units with inadequate imaging equipment).

Moreover, the advancement of our clinical best practice by LUS is evident considering the prospect of minimizing radiation exposure of adults, but, more important, of pregnant women and children. In the past few years, referral to our emergency room with the final LUS diagnosis of pneumonia included adults, but also pregnant young women and children; the diagnosis, as a rule, was confirmed by chest x-ray (CXR) in adults and, in cases of uncertainty, in children. We would respectfully add that the association of pneumonia with even a small pleural effusion is relatively frequent in our experience; it is an easy to detect clues that are worthy of attention because they may address, concurrently with the chest area(s) abnormalities detected by physical examination and the pain possibly reported by the patient (Fig 1), to a greater focus of LUS.

Figure Jump LinkFigure 1 A, B, Two images of the same pulmonary consolidation, with different deep setting, in a 8-year-old child referred to the ED for acute chest pain and fever. The scan was performed by a convex probe in the region of pain indicated by the patient. Chest radiograph confirmed the diagnosis of pneumonia.Grahic Jump Location

We strongly agree that a “significant reduction in CXR assessment is possible when LUS is used as the initial diagnostic imaging test. It may be feasible and safe to substitute LUS for CXR when evaluating children with suspected pneumonia.” Nonetheless, the need for comprehensive training with an adequate duration, both in elective and emergency US procedures, is still of pivotal relevance,, and such expertise should be adequately guaranteed and disseminated. When LUS is used alone, one encounters limitations in nonsubpleural pneumonitis that are not accessible by US, a fact that can explain LUS pitfalls. Conversely, the smaller subpleural pneumonitis consolidation can skip the sensibility of CXR, being well visible by LUS. Moreover, LUS is a very suitable and repeatable procedure for monitoring subpleural pneumonitis consolidation and response to therapy.

References

Jones B.P. .Tay E.T. .Elikashvili I. .et al Feasibility and safety of substituting lung ultrasonography for chest radiography when diagnosing pneumonia in children: a randomized controlled trial. Chest. 2016;150:131-138 [PubMed]journal
 
Catalano D. .Trovato G. .Sperandeo M. .Sacco M.C. . Lung ultrasound in pediatric pneumonia. The persistent need of chest X-rays. Pediatr Pulmonol. 2014;49:617-618 [PubMed]journal. [CrossRef] [PubMed]
 
Chavez M.A. .Naithani N. .Gilman R.H. .et al Agreement between the world health organization algorithm and lung consolidation identified using point-of-care ultrasound for the diagnosis of childhood pneumonia by general practitioners. Lung. 2015;193:531-538 [PubMed]journal. [CrossRef] [PubMed]
 
Stolz L.A. .Muruganandan K.M. .Bisanzo M.C. .et al Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department. Trop Med Int Health. 2015;20:1067-1072 [PubMed]journal. [CrossRef] [PubMed]
 
Trovato F.M. .Musumeci G. . Thoracic ultrasound limitations in the differential diagnosis of respiratory failure causes. Chest. 2015;148:e186- [PubMed]journal
 

Figures

Figure Jump LinkFigure 1 A, B, Two images of the same pulmonary consolidation, with different deep setting, in a 8-year-old child referred to the ED for acute chest pain and fever. The scan was performed by a convex probe in the region of pain indicated by the patient. Chest radiograph confirmed the diagnosis of pneumonia.Grahic Jump Location

Tables

References

Jones B.P. .Tay E.T. .Elikashvili I. .et al Feasibility and safety of substituting lung ultrasonography for chest radiography when diagnosing pneumonia in children: a randomized controlled trial. Chest. 2016;150:131-138 [PubMed]journal
 
Catalano D. .Trovato G. .Sperandeo M. .Sacco M.C. . Lung ultrasound in pediatric pneumonia. The persistent need of chest X-rays. Pediatr Pulmonol. 2014;49:617-618 [PubMed]journal. [CrossRef] [PubMed]
 
Chavez M.A. .Naithani N. .Gilman R.H. .et al Agreement between the world health organization algorithm and lung consolidation identified using point-of-care ultrasound for the diagnosis of childhood pneumonia by general practitioners. Lung. 2015;193:531-538 [PubMed]journal. [CrossRef] [PubMed]
 
Stolz L.A. .Muruganandan K.M. .Bisanzo M.C. .et al Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department. Trop Med Int Health. 2015;20:1067-1072 [PubMed]journal. [CrossRef] [PubMed]
 
Trovato F.M. .Musumeci G. . Thoracic ultrasound limitations in the differential diagnosis of respiratory failure causes. Chest. 2015;148:e186- [PubMed]journal
 
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