Ультразвуковое исследование легких в диагностике острых респираторных инфекций нижних дыхательных путей у детей

Abstract

The relevance of the study of lower respiratory tract infections in children is due to their high incidence and severity of the course. The main method of differential diagnosis is chest X-ray. However, the method is associated with radiation exposure. Currently, a promising and safe method for diagnosing lung pathology is ultrasound. The purpose — to determine the diagnostic capabilities of lung ultrasound in children with lower respiratory tract infections. Material and methods. A single-center prospective study was conducted, which included the results of observation of 52 patients aged from 1 month to 17 years with lower respiratory tract infections in the form of bronchitis, bronchiolitis and pneumonia. All children underwent chest X-ray and lung ultrasound. Ultrasonic devices Mindrey M7 (China), Logiq E9 (USA) (linear sensor 5–10 MHz) and X-ray device Gamma RenMedProm (Russia) were used. Results. Ultrasound of lungs revealed pathological changes in 38 (73.1%) patients. The bronchogram phenomenon was found most frequently (81.5%, n = 31); consolidation and interstitial syndrome were detected much less frequently — in 15.8% (n = 6) and 13.2% (n = 5) of cases. Lung ultrasound has a better informative value for detecting pleural effusion compared to chest X-ray. Effusion was present in 31.6% of patients (n = 12) by ultrasound, while by chest X-ray only in 2.9% (n = 1). Ultrasound is the most informative for assessing segments1, 2, 9, as well as subpleural sections; it is the least informative for basal departments. The sensitivity of ultrasound was 89.3%, the specificity was 63.6%. Conclusion. The advantage of ultrasound in comparison with chest X-ray is the good accessibility of the location of segments 1, 2, 9, subpleural sections, the detection of pleural effusion (from 1 mm), as well as the absence of radiation exposure, the possibility of conducting a study at the patient’s bed, and of monitoring. In order to reduce radiation exposure, it is advisable to perform a screening ultrasound of the lungs in all patients with lower respiratory tract infections, followed by a decision on the need for chest X-ray.