Pleural effusion in pediatric patients submitted to liver transplantation: ultrasound and radiological assessment

Abstract

ObjectiveTo evaluate the ability of bedside lung ultrasound todiagnose and quantify pleural effusion in pediatricpatients submitted to liver transplantation, in compari-son with supine chest radiograph.Patients and methods30 pediatric patients (mean age: 36 months, mean PIM211%) with end stage liver failure submitted to livertransplantation from living/dead donor (split). All thepatients during the first three postoperative days weresubmitted to supine chest radiograph and bedside lungultrasound, during mechanical ventilation or NIV.Three measurements were made in first, second, andthird postoperative day: chest x-ray was performed witha portable set; bedside lung ultrasound detected thepleural effusion at the PLAPS (posterolateral alveolar orpleural syndromes) point. The depth of the pleural effu-sion was evaluated according with the quad sign: thespace outlined between the pleural line and the pulmon-ary line (indicating the visceral pleura).Atelectasis, lung consolidation and pleural effusion arecommon in pediatric patients submitted to liver transplan-tation during the first postoperative days: chest radiographshowed to lack sensitivity in detecting pleural effusion andin differentiating atelectasis from pleural effusion, which iseasy instead with lung ultrasound.Ultrasound can detect the echogenicity of the effusionand help to assess the nature of it, measuring also itseffective volume.Statistically lung ultrasound has better sensitivity (80%)and specificity (90%), compared to chest radiograph,respectively 70% and 70%.ConclusionLung ultrasound is more sensitive and even more speci-fic in comparison to chest radiograph to detect andmeasure pleural effusion in children submitted to livertransplantation.