Lung ultrasonography to diagnose community-acquired pneumonia in children

Nicola Principi,Susanna Esposito,Caterina Giannitto,Andrea Esposito

doi:10.1186/s12890-017-0561-9

Abstract

BackgroundEarly diagnosis of community-acquired pneumonia (CAP) is essential to reduce the total burden of this disease. Traditionally, chest radiography (CR) is used to identify true CAP. However, CR is not a perfect diagnostic test for CAP. The use of lung ultrasonography (LUS) has been suggested as an alternative to overcome the problems associated with CR and increase the feasibility and accuracy of CAP diagnosis. LUS has largely been used for the diagnosis of several lung problems, including CAP, in adult patients with satisfactory results. Experience with LUS in children has grown over recent years. The main aim of this paper is to discuss the advantages and limits of LUS in the diagnosis of paediatric CAP.DiscussionThe presence of a consolidation pattern during LUS may represent pneumonia or atelectasis, although this conclusion is operator dependent. An overall agreement between LUS and CR was observed in most of the studies that were examined. In most reports where a disagreement between the two methods was found, CR was not able to identify the cases that were correctly diagnosed by LUS, particularly when CR was performed only with postero-anterior/antero-posterior projection and consolidation was observed in lung areas that are poorly visualized by CR. However, the lack of standardized LUS methods is problematic. Finally, the real advantage of LUS for the diagnosis of CAP in children remains unclear.SummaryLUS is an interesting diagnostic modality that appears a useful first imaging test in children with suspected CAP. However, the methods used to perform LUS in children are not precisely standardized, and the diagnosis of interstitial CAP is inaccurate. Further studies are needed before LUS can be routinely used in everyday paediatric practice.

Highlights

Diagnosis of community-acquired pneumonia (CAP) is essential to reduce the total burden of this disease
Further studies are needed before lung ultrasonography (LUS) can be routinely used in everyday paediatric practice
It should be highlighted that any CAP must be extended to the pleural surface to be diagnosed by LUS because examination of the central structures is prevented by the barrier created by the pleural–lung interface

Summary

Introduction

Diagnosis of community-acquired pneumonia (CAP) is essential to reduce the total burden of this disease. The use of lung ultrasonography (LUS) has been suggested as an alternative to overcome the problems associated with CR and increase the feasibility and accuracy of CAP diagnosis. The incidence of community-acquired pneumonia (CAP) in the paediatric population has significantly decreased. It is likely that the widespread use of effective preventive measures, such as conjugate vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae, two of the most common bacterial pathogens that cause paediatric CAP, has played a major role in this regard [1]. CAP remains a common cause of paediatric morbidity and mortality. Diagnosis of CAP is essential to reduce the total burden of the disease. In a significant number of children, CAP remains a diagnostic

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