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Jing Liu, MD, PhD
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

Department of Neonatology and NICU of Bayi Children’s Hospital, the Army General Hospital of the Chinese PLA, Beijing, China

CORRESPONDENCE TO: Jing Liu, MD, PhD, Department of Neonatology and NICU of Bayi Children’s Hospital, the Army General Hospital of the Chinese PLA, Beijing 100700, China


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


Chest. 2016;150(4):978-979. doi:10.1016/j.chest.2016.07.018
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I appreciate Dr Sperandeo et al for their attention and insightful comments in response to the recent publication by my colleagues and me on the use of lung ultrasonography (LUS) to diagnose transient tachypnea of the newborn (TTN). Sperandeo et al's professional knowledge of LUS, their publications, and comments on our publication have expanded my understanding in this field.

To a certain extent, my colleagues and I agree with the comments by Sperandeo et al, particularly in the context of the great developmental potential of LUS for diagnosing lung diseases more accurately. However, we hold some different viewpoints about LUS.

First, because subpleural lung tissues are located at the termini of the bronchial tubes and blood supply, they are more likely to suffer from a variety of lung diseases.

Second, neither normal chest radiography nor clinical manifestations can exclude the existence of lung disease, whereas LUS is more accurate and reliable for diagnosing lung diseases. When diagnosing neonatal pulmonary atelectasis (NPA), the sensitivity of chest radiography was only 75%, whereas the sensitivity of LUS was 100%. Atelectasis that was detected on chest CT scanning, after failing to be detected by chest radiography, was termed “occult lung atelectasis”; in contrast, all such occult lung atelectasis was detected by LUS. The failure to detect atelectasis by chest radiography may be due to the following factors:

  • 1.

    The area of atelectasis might be too small to produce clinical symptoms.

  • 2.

    The position of the infant and direction of the radiation beam might hinder the detection of atelectasis in some areas, such as deep areas in the lungs or the posterior lungs.

  • 3.

    The radiation beam might not be sufficiently strong to detect tiny areas of atelectasis.

  • 4.

    Spontaneous breathing or mechanical ventilation might result in chest radiographic images obtained during expiration. In contrast, LUS can detect small areas of atelectasis in almost any part of the lungs, regardless of the position of the patient. This greater sensitivity is also one of the reasons that some experienced experts have recently suggested replacing chest radiography with LUS in the neonatal ward.

  • 5.

    My colleagues and I have reservations about the example provided by Sperandeo et al, in which the pictures are presented as correct. This assertion is based on the hypothesis that chest radiography is the “gold standard,” but the “standard” itself remains controversial, as is the case for comparisons of brain CT scanning and MRI. In some cases, the brain is functionally normal, yet MRI reveals anatomical injuries, whereas the CT scan reveals no abnormal findings. Under this condition, the brain cannot be considered normal, because MRI is more accurate and preferable than CT in diagnosing brain conditions.

Third, it is true that there are no specific lung signs for any lung diseases. Therefore, it is necessary to comprehensively analyze the ultrasonic findings in the diagnosis of lung diseases when using LUS. Some distinct and relatively specific ultrasonographic characteristics have been explored in differentiating lung diseases such as neonatal pneumonia and NPA. For instance, the typical ultrasonic signs of pneumonia and NPA are large areas of consolidation with air bronchograms; pneumonia has irregular margins (jagged edges), and NPA has regular margins in most cases.,

Finally, please note that my colleagues and I agree with Copetti and Cattarossi and Lichtenstein et al that “double lung point” is one of the LUS signs of transient tachypnea of the newborn and that “lung point” is one of the LUS signs of pneumothorax.

In summary, the comments from Sperandeo et al have produced more in-depth thoughts about LUS that will help me and my colleagues improve our clinical practices in the future.

References

Liu J. .Chen X.X. .Li X.W. .Wang Y. .Chen S.W. .Fu W. . Lung ultrasonography to diagnose transient tachypnea of the newborn. Chest. 2016;49:1269-1275 [PubMed]journal
 
Liu J. .Chen S.W. .Liu F. .et al The diagnosis of neonatal pulmonary atelectasis using lung ultrasonography. Chest. 2015;147:1013-1019 [PubMed]journal. [CrossRef] [PubMed]
 
Cattarossi L. .Copetti R. .Poskurica B. . Radiation exposure early in life can be reduced by lung ultrasound. Chest. 2011;139:730-731 [PubMed]journal. [CrossRef] [PubMed]
 
Liu J. .Liu F. .Liu Y. .et al Lung ultrasonography for the diagnosis of severe pneumonia of the newborn. Chest. 2014;146:483-488 [PubMed]journal. [CrossRef]
 
Copetti R. .Cattarossi L. . The “double lung point”: an ultrasound sign diagnostic of transient tachypnea of the newborn. Neonatology. 2007;91:203-209 [PubMed]journal. [PubMed]
 
Lichtenstein D.A. .Meziere G. .Biderman P. .et al The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26:1434-1440 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

References

Liu J. .Chen X.X. .Li X.W. .Wang Y. .Chen S.W. .Fu W. . Lung ultrasonography to diagnose transient tachypnea of the newborn. Chest. 2016;49:1269-1275 [PubMed]journal
 
Liu J. .Chen S.W. .Liu F. .et al The diagnosis of neonatal pulmonary atelectasis using lung ultrasonography. Chest. 2015;147:1013-1019 [PubMed]journal. [CrossRef] [PubMed]
 
Cattarossi L. .Copetti R. .Poskurica B. . Radiation exposure early in life can be reduced by lung ultrasound. Chest. 2011;139:730-731 [PubMed]journal. [CrossRef] [PubMed]
 
Liu J. .Liu F. .Liu Y. .et al Lung ultrasonography for the diagnosis of severe pneumonia of the newborn. Chest. 2014;146:483-488 [PubMed]journal. [CrossRef]
 
Copetti R. .Cattarossi L. . The “double lung point”: an ultrasound sign diagnostic of transient tachypnea of the newborn. Neonatology. 2007;91:203-209 [PubMed]journal. [PubMed]
 
Lichtenstein D.A. .Meziere G. .Biderman P. .et al The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26:1434-1440 [PubMed]journal. [CrossRef] [PubMed]
 
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