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Correspondence |

Lung Ultrasonography in Diagnosis of Transient Tachypnea of the Newborn: Limitations and Pitfalls FREE TO VIEW

Marco Sperandeo, MD; Gaetano Rea, MD; Alfredo Santantonio, MD; Vincenzo Carnevale, MD
Author and Funding Information

Editor’s Note: Authors are invited to respond to Correspondence that cites their previously published work. Those responses appear after the related letter. In cases where there is no response, the author of the original article declined to respond or did not reply to our invitation.

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aUnit of Interventional Ultrasound of Internal Medicine, IRCCS Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy

bDepartment of Internal Medicine, IRCCS Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy

cDepartment of Radiology, Monaldi Hospital, Naples, Italy

dDivision of Neonatology, Monaldi Hospital, Naples, Italy

CORRESPONDENCE TO: Marco Sperandeo, MD, IRCCS Hospital Casa Sollievo della Sofferenza, Unit of Interventional Ultrasound of Internal Medicine, Viale Cappuccini 1, 71013, San Giovanni Rotondo (FG), Italy


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


Chest. 2016;150(4):977-978. doi:10.1016/j.chest.2016.06.048
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Liu et al investigated the possible use of thoracic ultrasonography (TUS) to diagnose transient tachypnea of the newborn in a large sample of infants. In such patients, the use of TUS, a safe radiation-free repeatable technique that is easy to perform, would be extremely appealing; it can also be used in emergency settings with portable devices. However, Liu et al's study raises relevant concerns.

First, because of the anatomical constraints of the thoracic cage, TUS at its best explores about 70% of the pleural surface. Even in amenable zones, TUS visualizes only the lesions adherent to the pleural surface. Moreover, TUS may provide similar patterns in many diseases reducing lung aeration in the subpleural surface and does not distinguish among different causes of consolidation, for instance between pneumonia and atelectasis, which may coexist. In addition, even children with normal lungs often display subsegmental lung focal areas of atelectasis beyond terminal bronchioles (Fig 1). The picture is further compounded by artifacts, predominantly B lines. The latter are generated behind the pleural line by the elevated difference of acoustic impedance between either soft tissue or fluid and gas. B lines may be detected in several pleuropulmonary diseases; their number has low specificity and does not allow discrimination between different conditions. In summary, no feature of TUS can be considered at all disease specific. In addition, the authors particularly emphasized the results concerning “linear/arborescent bronchograms.” However, to our knowledge, no study or meta-analysis hitherto has demonstrated that they really match the anatomy of the bronchial tree or the CT finding of an air bronchogram, this TUS sign being detectable even in lung neoplasms. The authors also stressed the sign of the “double lung point,” which is a TUS sign of pneumothorax. The same term has been used previously to describe a TUS sign of transient tachypnea of the newborn subsequently renamed “double transition point.” Finally, the authors did not provide information on several settings parameters (time gain compensation, tissue harmonics, and electronic focus), which may affect the ultrasonographic pattern.

Figure Jump LinkFigure 1 A and B, Chest radiograph in a child (posterior-anterior, latero-lateral views) are normal. C, Transthoracic ultrasonogram: right posterior basal subpleural small hypoechoic focal area of atelectasis (arrow).Grahic Jump Location

Considering all the mentioned technical concerns, we believe that many statements included in the paper of Liu et al should be more prudent. In particular, the authors did not specify that the utility of TUS may be invaluable only after a clinical and radiological diagnosis have been made. The negative ethical and medicolegal implications of skipping these steps, particularly when addressing a therapeutic choice, are quite evident.

References

Liu J. .Chen X.-X. .Li X.-W. .Chen S.-W. .Wang Y. .Fu W. . Lung ultrasonography to diagnose transient tachypnea of the newborn. Chest. 2016;149:1269-1275 [PubMed]journal. [CrossRef] [PubMed]
 
Riccabona M. . Ultrasound of the chest in children (mediastinum excluded). Eur Radiol. 2008;18:390-399 [PubMed]journal. [CrossRef] [PubMed]
 
Sperandeo M. .Varriale A. .Sperandeo G. . Assessment of ultrasound acoustic artifacts in patients with acute dyspnea: a multicenter study. Acta Radiol. 2012;53:885-892 [PubMed]journal. [CrossRef] [PubMed]
 
Sperandeo M. .Filabozzi P. .Carnevale V. . Ultrasound diagnosis of ventilator-associated pneumonia: a not-so-easy issue. Chest. 2016;149:- [PubMed]journal
 
Zhang Z. . Double lung point in an 18-month-old child: a case report and literature review. J Thorac Dis. 2015;7:E50-E53 [PubMed]journal. [PubMed]
 

Figures

Figure Jump LinkFigure 1 A and B, Chest radiograph in a child (posterior-anterior, latero-lateral views) are normal. C, Transthoracic ultrasonogram: right posterior basal subpleural small hypoechoic focal area of atelectasis (arrow).Grahic Jump Location

Tables

References

Liu J. .Chen X.-X. .Li X.-W. .Chen S.-W. .Wang Y. .Fu W. . Lung ultrasonography to diagnose transient tachypnea of the newborn. Chest. 2016;149:1269-1275 [PubMed]journal. [CrossRef] [PubMed]
 
Riccabona M. . Ultrasound of the chest in children (mediastinum excluded). Eur Radiol. 2008;18:390-399 [PubMed]journal. [CrossRef] [PubMed]
 
Sperandeo M. .Varriale A. .Sperandeo G. . Assessment of ultrasound acoustic artifacts in patients with acute dyspnea: a multicenter study. Acta Radiol. 2012;53:885-892 [PubMed]journal. [CrossRef] [PubMed]
 
Sperandeo M. .Filabozzi P. .Carnevale V. . Ultrasound diagnosis of ventilator-associated pneumonia: a not-so-easy issue. Chest. 2016;149:- [PubMed]journal
 
Zhang Z. . Double lung point in an 18-month-old child: a case report and literature review. J Thorac Dis. 2015;7:E50-E53 [PubMed]journal. [PubMed]
 
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