The role of chest ultrasonography in the management of respiratory diseases: document II (original) (raw)
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The role of chest ultrasonography in the management of respiratory diseases: document I
Multidisciplinary Respiratory Medicine, 2013
Chest ultrasonography can be a useful diagnostic tool for respiratory physicians. It can be used to complete and widen the general objective examination also in emergency situations, at the patient's bedside. The aim of this document is to promote better knowledge and more widespread use of thoracic ultrasound among respiratory physicians in Italy. This document I is focused on basic knowledge of chest ultrasonography technique, physical basis, aims and characteristics, fields of application. Document I shows how chest ultrasonography can be useful to detect and monitor pleural diseases, pleural effusions and pneumothorax and how it can assess diaphragmatic kinetics and pathologies.
Point-of-Care Chest Ultrasound in the Neonatal Intensive Care Unit: An Italian Perspective
Lung ultrasound outperforms conventional radiology in the emergency diagnosis of pneumothorax and pleural effusions. Neonatologists and pedia-tricians are now adapting lung ultrasound to their specific clinical issues. The normal image is relatively unchanged throughout the age span, whereas progressively fading B-lines (comet-tail artifacts) describe the fluid-to-air transition of the neonatal lung. Also, an homogeneous white (hyperechogenic) lung with pleural image abnormalities and absence of spared areas is accurate in diagnosing respiratory distress syndrome. The evidence of bilateral confluent B-lines in the dependent areas of the lung (''white lung'') and normal or near-normal appearance of the lung in the superior fields is highly sensitive and specific for transient tachypnea of the newborn. Infantile pneumonia has recently been proved to be accurately diagnosed by ultrasound after a short training period. In summary, chest ultrasonography is not yet ready to replace conventional chest radiology. However, when appropriately applied, a lung ultrasound scan can save time and radiation exposure to achieve a critical diagnosis. Objectives After completing this article, readers should be able to: 1. Understand the propagation of ultrasound through the chest and the meaning of the main artifactual images. 2. Correlate profiles of ultrasound artifacts with specific lung diseases. 3. Appreciate the current clinical literature validating point-of-care lung ultrasound in pediatrics and neonatology.
Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis
Background: Clinical assessment is the gold standard for diagnosis of bronchiolitis. To date, only one study found LUS (Lung Ultrasound) to be a valuable tool in the diagnosis of bronchiolitis. Aim of this study is to evaluate the accuracy of lung ultrasonography in the diagnosis and management of bronchiolitis in infants. Methods: This was an observational cohort study of infants admitted to our Pediatric Unit with suspected bronchiolitis. A physical examination and lung ultrasound scans were performed on each patient. Diagnosis and grading of bronchiolitis was assessed according to a clinical and a ultrasound score. An exploratory analysis was used to assess correspondence between the lung ultrasound findings and the clinical evaluation and to evaluate the inter-observer concordance between the two different sonographs.
Usefulness of lung ultrasound in the diagnosis and follow-up of respiratory diseases in neonates
Anales de Pediatría (English Edition)
Objective: Lung ultrasound is a useful tool for diagnosis and follow-up of diseases in critically ill neonates. Its use is increasingly widespread thanks to its advantages over other imaging tests and the rapidly growing body of evidence to support it, and ''point-of-care ultrasound'' (POCUS) has become a key component in neonatal guidelines. The objective of this special article is to present the foundations and the established diagnostic and therapeutic applications of lung ultrasonography as well as introducing new applications. Methods and results: The Lung Ultrasound Section of the Neonatal Ultrasonography Working Group of the Spanish Neonatology Society has summarised the current scientific evidence. The article describes the sonographic features of the most common respiratory diseases, discusses some of the applications of ultrasound in neonatal care (such as prediction of admission and need of surfactant, ultrasound-guided procedures or monitoring of lung development in premature infants) and proposes its introduction in other scenarios in which its use is not quite established at present, such as resuscitation or respiratory management. This article reaffirms the usefulness of lung ultrasound in guiding diagnosis, clinical decision-making and prognosis and facilitating procedures.
Chest Ultrasound Helps to Diagnose Pulmonary Consolidations in Pediatric Patients
Journal of Medical Ultrasound, 2011
The diagnosis of pneumonia in pediatric patients relies on physical examination, blood tests, and chest X-rays. Physical examination, blood tests, and chest X-rays have a low accuracy, that is even greater in the critically ill. These limitations along with the risk of ionizing radiations, mandate the search for a safe diagnostic tool for patients with suspected pneumonia. Ultrasound (US) imaging offers several advantages over traditional radiographic techniques: it is non-invasive, painless, and involves minimal contact. In case of pulmonary parenchymal lesions, US is useful for differentiating pulmonary consolidation or atelectasis from lung masses and pleural lesions. Detection of air or fluid bronchograms at US and of pulmonary vessels with color flow imaging, is essential for the differential diagnosis of parenchymal consolidations. Furthermore US has a role in the evaluation of mediastinal masses and characterization of pleural fluid collection. Chest US is an ideal modality for serial examinations in rapidly evolving disease processes.
Lung ultrasound in diagnosing and monitoring pulmonary interstitial fluid
La radiologia medica, 2012
Chronic heart failure is a complex clinical syndrome often characterised by recurrent episodes of acute decompensation. This is acknowledged as a major public health problem, leading to a steadily increasing number of hospitalisations in developed countries. In decompensated heart failure, the redistribution of fluids into the pulmonary vascular bed leads to respiratory failure, a common cause of presentation to the emergency department. The ability to diagnose, quantify and monitor pulmonary congestion is particularly important in managing the disease. Lung ultrasound (US) is a relatively new method that has gained a growing acceptance as a bedside diagnostic tool to assess pulmonary interstitial fluid and alveolar oedema. The latest developments in lung US are not because of technological advance but are based on new applications and discovering the meanings of specific sonographic artefacts designated as B-lines. Real-time sonography of the lung targeted to detection of B-lines allows bedside diagnosis of respiratory failure due to impairment of cardiac function, as well as quantification and monitoring of pulmonary interstitial fluid. Lung US saves time and cost, provides immediate information to the clinician and relies on very easy-toacquire and highly reproducible data.
Lung ultrasound in children, WFUMB review paper (part 2)
Medical Ultrasonography
Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, real-time imaging, and lack of ionizing radiation and bedside availability. In the current World Federation of Societies for Ultra-sound in Medicine and Biology (WFUMB) paper series so far (part I) the topic has been introduced and the technical require-ments explained. In the present paper the use of US in the lung in paediatric patients is analysed. Lung diseases including the interstitial syndrome, bacterial pneumonia and viral infections, CoViD findings, atelectasis, lung consolidation, bronchiolitis and congenital diseases of the respiratory system including congenital pulmonary airway malformation (CPAM) and sequester but also pneumothorax are discussed.
The Egyptian Journal of Hospital Medicine, 2019
Background: respiratory distress is the primary diagnosis in nearly 50% of children admitted to the pediatric emergency room and is a common cause of cardiopulmonary arrest in children. There is substantial variability in the etiology and severity of illness. The presenting clinical findings usually help to determine the type of problem. The causes include pneumonia, bronchial asthma, pneumothorax, acute bronchiolitis and pleural effusion. Objective: the present study was designed to compare chest ultrasound, as a diagnostic tool in the diagnosis of children with acute conditions of RD with the diagnosis of other radiological tools (Chest X-ray and CT chest. Methodology: this study included 200 infants and children, attending the Paediatric Department in Sayed Galal and Al-Hussein, AL-Azhar University Hospitals and they were suffering from respiratory distress. Their ages ranged from 12 month to 60months with mean age 32.52 months ± 13.91 months. Males were 134/200 (67%) while, females were 66/200 (33%) with male to female ratio 2.03:1. Results: as regard distribution of patients according to clinical or radiological diagnosis, the study showed that uncomplicated pneumonia n84 (42.0%), pneumonia with effusion n32 (16.0%), non pneumonic effusion n8 (4.0%), lung abscess n4 (2.0%), pneumothorax n14 (7.0%), lung collapse n16 (8.0%), mediastinal mass n4 (2.0%) and acute bronchiolitis n38 (19.0%). Conclusion: from our study, we can conclude the following: in view of our study it can be concluded that, chest US offers an important contribution to the diagnostic procedures of pleuro-pulmonary disorders in children, as pneumonia, pneumothorax, pleural effusion, lung abscess, lung collapse, mediastinal mass and acute bronchiolitis.
Point-of-care chest ultrasound in the Neonatal Intensive Care Unit Proceedings
Chest ultrasound is a useful diagnostic tool in adult emergency medicine. Echography does not generate a clear image of the lung but is able to generate artifacts that are combined in disease-specific profiles. Reflections of the pleural image appear as short straight lines also known as A-lines. Vertical, comet-tail artifacts departing from the pleura are named B-lines. The former are present in the normal lung while the latter have been described in the adult wet lung. Lung ultrasonography outperforms conventional radiology in the emergency diagnosis of pneumothorax and pleural effusions. Neonatologists and pediatricians are now adapting lung ultrasound to their specific clinical issues. The normal image is relatively unchanged throughout the age span, while progressively fading B-lines describe the fluid-to-air transition of the neonatal lung. Also, an homogeneous white (hyperechogenic) lung with pleural image abnormalities and absence of spared areas is accurate in diagnosing Respiratory Distress Syndrome (RDS). The prevalence of A-lines in the upper lung fields with B-lines at the bottom fields (aka double lung point artifact) is highly sensitive and specific in describing Transient Tachypnea of the Newborn. Infantile pneumonia has recently been proved an accurate diagnosis by ultrasound after a short training. In summary, chest ultrasonography has no ground to replace conventional chest radiology tout court. However, when appropriately applied, a lung ultrasound scan can save time and radiation exposure to achieve a critical diagnosis.