Alveolar-interstitial Syndrome Research Articles

Lung Ultrasound Findings in the Diagnosis of Transient Tachypnea of Newborn in Late Preterm and Term Neonates

Background: Transient tachypnea of the newborn (TTN) is a prevalent etiology of respiratory distress (RD) in neonates. The condition is a result of the accumulation of fetal lung fluid owing to defective processes responsible for its removal. However, differentiating TTN from various etiologies of RD may provide challenges. Lung ultrasound (LUS) has effectively been used to diagnose and differentiate infant RD. The objective of this research was to evaluate the ultrasonographic findings in the diagnosis of TTN in late preterm and full-term neonates.
 Methods: All neonates had been exposed to full taking of history, full clinical assessment, chest X-ray, routine laboratory tests, and LUS assessment was performed on 80 late preterm and full-term neonates diagnosed with TTN by clinical and radiological findings and performed on control group.
 Results: Among 80 neonates who were diagnosed to have TTN, double lung point sign (DLP) was present in 62 (77. 5 %), pleural line abnormalities had been observed in 80 (100%), alveolar interstitial syndrome (AIS) was observed in 68 (85.0%), while white lung was present only in 12 TTN cases (15%), and no pleural effusion was found in any of the patients. While these findings weren’t detected in the control group.
 Conclusion: LUS could be accurately and reliably used in the diagnosis and screening of TTN. Most common findings in TTN were pleural line abnormalities followed by AIS and DLP.

Bedside ultrasound in post-anaesthetic care unit for the diagnosis of post-extubation negative pressure pulmonary oedema: A paediatric case.

Post-extubation negative pressure pulmonary oedema is a rare, potentially life-threatening complication associated with general anaesthesia. Chest radiography is used as a diagnostic tool, but it implies a non-negligible radiation exposure, a very important consideration, especially for the paediatric population. However, lung ultrasound can overcome this problem and can be used to detect postoperative pulmonary complications. A 16-year-old male was scheduled for tympanoplasty. General anaesthesia was conducted, and after extubation, the patient developed a laryngospasm. On arrival at the post-anaesthetic care unit, the patient started to cough, a pink frothy sputum and hypoxemia were noticed, and auscultation revealed crepitations. A bedside lung ultrasound showed more than three B-lines per intercostal window, suggesting an alveolar-interstitial syndrome. With this case report, we would like to raise awareness to this clinical entity and demonstrate bedside ultrasound has an important role in the diagnostic and therapeutic assessment during the perioperative period.

Bile Acids Pneumonia: A Respiratory Distress Syndrome in Early-Term Neonates.

Intrahepatic cholestasis of pregnancy (ICP) complicates among 0.2-2% of pregnancies and has been associated with adverse perinatal outcomes, including sudden stillbirth, meconium strained fluid, preterm birth, perinatal asphyxia, and transient tachypnea of the newborn. The diagnosis of "bile acids pneumonia" was previously proposed and a causative role of bile acids (BA) was supposed with a possible mechanism of action including surfactant dysfunction, inflammation, and chemical pneumonia. In the last few years, the role of lung ultrasound (LUS) in the diagnosis and management of neonatal respiratory distress syndrome has grown, and LUS scores have been introduced in the literature, as an effective predictor of the need for surfactant treatment among neonates with respiratory distress syndrome. We present four cases of infants born from pregnancies complicated by ICP, who developed respiratory distress syndrome early after birth. Lung ultrasound showed the same pattern for all infants, corresponding to a homogeneous alveolar-interstitial syndrome characterized by a diffuse coalescing B-line pattern (white lung). All infants evaluated require non-invasive respiratory support and in three cases surfactant administration, despite the near-term gestational age, with rapid improvement of respiratory disease and a good clinical outcome.

The Accuracy of Various Lung Ultrasonography Findings in Predicting the Necessity for Surfactant Treatment in Neonates With Respiratory Distress Syndrome

Objective: The study was conducted to determine the value of various lung ultrasonography (LUS) findings in diagnosing neonatal respiratory distress syndrome (RDS) and to assess the ability of ultrasonography to predict the need for surfactant treatment. Materials and Methods: This cohort study was conducted on 164 neonates with RDS with a gestational age of over 28 weeks. Transthoracic sonography was performed in all patients in the infant isolet immediately after admission and stabilization of the infant and during the first 6 hours before surfactant treatment. Immediately after the sonogram, the neonates underwent an anterior–posterior view chest radiograph, before and after surfactant treatment. Results: In comparison with clinical manifestations and radiographic findings as the references, the sensitivity and specificity of each of the LUS-related parameters for detecting RDS were as follows: Faded A-lines (95.4% and 76.7%), abnormal B-lines (91.7% and 71.6%), the presence of consolidation (90.9% and 88.3%), the presence of pleural effusion (95% and 86.7%), and alveolar–interstitial syndrome (AIS) (98% and 96%). Conclusion: LUS findings were valuable in assessing and grading the severity of neonatal RDS alongside clinical evaluation. LUS may assist in selecting infants for surfactant therapy and monitoring treatment response.

Lung ultrasonography versus chest CT for assessing peripheric pulmonary lesions in hemorrhagic fever with renal syndrome: a prospective comparative study in China.

To compare the performances of lung ultrasonography (LUS) versus chest CT for assessing peripheric pulmonary lesions in hemorrhagic fever with renal syndrome (HFRS). Paired LUS and chest CT scan were prospectively performed and compared when in diagnosing five pathologies including region with alveolar-interstitial pattern (RAIP), alveolar-interstitial syndrome (AIS), lung consolidation, pleural effusion (PE), and pericardial effusion, in each patient with HFRS. Forty-four patients (aged 39.9 ± 15.0years, 35 males) were included, from which 68 paired LUS and chest CT imaging data of 816 lung regions were obtained and analyzed. Compared with chest CT, LUS showed high sensitivity (92.19-100%) and negative predictive value (95.9-100%), but relatively low specificity (39.47-97.21%) and positive predictive value (37.5-76.47%) for diagnosing the above pathologies. McNemer's test showed LUS detected more positive findings than chest CT (all p ≤ 0.002). There was a strong correlation between LUS and chest CT scores (rs = 0.7141, p < 0.0001) and both scores correlated with the disease severity, hospital days, and partial laboratory profiles in HFRS patients. LUS was comparable with chest CT for diagnosing peripheric pulmonary lesions and clinical assessment in patients with HFRS. Given the high sensitivity and negative predictive value compared with chest CT, LUS can be used as an excellent rule-out tool in HFRS, while its use in rule-in still requires more evidence. Considering the obvious advantages of LUS being a bedside, less expansive, and non-radiating exam, future multi-center randomized LUS versus chest CT studies may help to guide the preferred method. • LUS could detect more positive findings than chest CT in assessing peripheric pulmonary lesions in patients with hemorrhagic fever with renal syndrome (HFRS). • Compared with chest CT, LUS showed high sensitivity but relatively low specificity when diagnosing the peripheric pulmonary lesions caused by HFRS. • Both LUS and chest CT scores correlated with the disease severity, hospital days, and partial laboratory profiles in HFRS.

Feasibility of ultrasound in the diagnosis of neonatal respiratory distress syndrome in preterm infants.

The aim of this study was to investigate the feasibility of lung ultrasound in the diagnosis of neonatal respiratory distress syndrome (NRDS) in preterm infants. One hundred and nine preterm infants were prospectively recruited. Three ultrasound diagnostic criteria were developed to diagnose preterm infants with NRDS: (A) thickened or not smooth pleural line, part of the lung field shows diffuse 'B-line' sign or alveolar-interstitial syndrome (AIS); (B) thickened or not smooth pleural line, all lung fields show AIS, signifying the 'white lung' sign; (C) thickened or rough pleural line, 'white lung' sign and 'lung consolidation' sign can be observed in any lung field. The sensitivity and negative predictive value of NRDS in preterm infants with diagnostic criteria A were 100%, but the specificity and positive predictive value were 67.95 and 55.36%, respectively. The specificity and positive predictive value of diagnostic criteria B and C were 100%, while the 95% CI of diagnostic criteria B was narrower than diagnostic criteria C. The sensitivity and negative predictive value of diagnostic criteria B were higher than that of diagnostic criteria C. Of the 31 NRDS cases, 15 cases had severe NRDS and the other 16 did not have severe NRDS. Thickened or rough pleural line with white lung sign is an important characteristic for the diagnosis of NRDS by lung ultrasound. White lung sign combined with the lung consolidation sign had high diagnostic efficacy when distinguishing severe NRDS from not severe NRDS.

The clinical value of lung ultrasound in premature infants with bronchopulmonary dysplasia.

This study aimed to explore the risk factors of bronchopulmonary dysplasia in premature infants and the clinical application value of lung ultrasound in the diagnosis of bronchopulmonary dysplasia. A total of 80 premature infants with a gestational age of <32 weeks or a birth weight of <1,500 g who were treated in our hospital from January to August 2021 were randomly divided into a bronchopulmonary dysplasia group (n=12) and a non-bronchopulmonary dysplasia group (n=62). The clinical data, lung ultrasound, and X-ray image characteristics of the two groups were compared. Among the 74 preterm infants, 12 preterm infants were diagnosed with bronchopulmonary dysplasia, and 62 preterm infants were determined not to have bronchopulmonary dysplasia. There were significant differences in sex, severe asphyxia, invasive mechanical ventilation, premature membrane ruptures, and intrauterine infection between the two groups (p<0.05). Lung ultrasound showed abnormal pleural lines and alveolar-interstitial syndrome in all 12 patients with bronchopulmonary dysplasia and vesicle inflatable signs in 3 patients. Before clinical diagnosis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of lung ultrasound in the diagnosis of bronchopulmonary dysplasia were 98.65, 100, 98.39, 92.31, and 100%, respectively. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of X-rays in the diagnosis of bronchopulmonary dysplasia were 85.14, 75.00, 87.10, 52.94, and 94.74%, respectively. The diagnostic efficiency of lung ultrasound for premature bronchopulmonary dysplasia is better than that of X-rays. The application of lung ultrasound can screen patients with bronchopulmonary dysplasia early for timely intervention.

Lung Ultrasound: A Complementary Imaging Tool for Chest X-Ray in the Evaluation of Dyspnea.

The present study was designed to evaluate the spectrum of imaging findings seen on chest ultrasonography in patients presenting with dyspnea and verify the concordance between chest X-ray and chest ultrasound. Methods Fifty-three patients presenting with dyspnea were included in this study. Patients with known/suspected cardiac disease were excluded from the study. All patients underwent chest X-ray and chest ultrasound, reported by two different investigators. The concordance was analyzed using Cohen's kappa value with a ' p -value' less than 0.05 considered statistically significant. Results Among the fifty-three patients with dyspnea, five diagnostic pathologies were evaluated. Concordance between lung ultrasound and chest X-ray for diagnosis of pneumonia, pneumothorax, acute exacerbation of COPD/severe asthma, and diffuse alveolar interstitial syndrome was found to be high with Cohen's kappa value > 0.8 ( p < 0.01). Ultrasound was able to correctly diagnose more cases of pneumothorax and pulmonary edema compared with chest X-ray with sensitivity and negative predictive value of 100%. Chest X-ray was found to be superior in correctly diagnosing COPD. The difference was, however, not statistically significant. Similarly, no statistically significant difference could be inferred between the diagnostic value of ultrasound and Chest X-ray in the diagnosis of pneumonia or pleural effusion. Conclusions A high concordance was noted between ultrasound and chest X-ray for diagnosis of all pathologies studied ( p < 0.01), the highest noted in pneumonia/pleural effusion and diffuse interstitial syndrome (κ = 0.9). Hence, ultrasound may be considered a complimentary imaging modality for Chest-X-ray in the evaluation of dyspnea.

Congenital Pulmonary Alveolar Proteinosis: An Exceptional Cause of Diffuse Interstitial Lung Disease

Introduction: Pulmonary alveolar proteinosis is a rare respiratory disease characterized by the accumulation of surfactant-derived material in the lungs. It is commonly revealed by progressively increasing exertional dyspnoea contrasting with a poor clinical examination in the context of a diffuse infiltrating pneumonia. Bronchoalveolar lavage is the key to diagnosis. Genetic PAPs are usually diagnosed at birth or in childhood. PAPs of genetic origin mainly include surfactant production disorders, lysinuric protein intolerances and mutations of the GM-CSF receptor. CSF treatment is ineffective. On the other hand, large therapeutic lung lavage seems to be effective. The course of PAP is variable, ranging from spontaneous resolution to death from respiratory failure or lung infection. Case Report: A 3- month-old girl with family history of first-degree consanguineous parents, who was having a background of a Progressive worsening of respiratory symptoms and who was referred to our department for the treatment of diffuse pneumonia. The respiratory functional explorations objectified a restrictive syndrome. Chest X-ray revealed Bilateral alveolar-interstitial syndrome with left basal condensation and a Chest CT scan showed diffuse infiltrating pneumopathy, reasons why a bronchoalveolar lavage was performed showing a milky appearance. It contains a large amount of proteinaceous eosinophilic acellular granular material, which is PAS - positive. There are also foamy macrophages with PAS-positive intracellular inclusions. Those data are consistent with the diagnosis of PAP. The genetic study had shown an alpha chain mutation of the GM-CSF receptor confirming the diagnosis of primary alveolar proteinosis of genetic origin. The Evolution After two therapeutic bronchoalveolar lavages of both lungs was favorable with a clear decrease in pulmonary signs of effort. Conclusion: Alveolar proteinosis is a rare etiology of chronic interstitial lung disease in children. The diagnosis of certainty is do ne thanks to BAL and the treatment is based on therapeutic BAL sessions. The primitive forms are frequent and their prognosis seems be inversely correlated with age at onset.

Poor pulmonary health in Barataria Bay dolphins in the eight years following the Deepwater Horizon oil spill

TheDeepwater Horizon(DWH) disaster resulted in large-scale contamination of bays, sounds, and estuaries in the northern Gulf of Mexico, home to multiple stocks of common bottlenose dolphins (Tursiops truncatus). Inhalation, aspiration, ingestion, and dermal absorption of oil and its toxic components were all considered possible routes of exposure for dolphins living within the oil spill footprint. To determine if dolphins were adversely impacted, catch-and-release health assessments were performed in heavily-oiled Barataria Bay (BB), Louisiana, and in Sarasota Bay (SB), Florida, a comparison site with no DWH oil contamination. Initial studies were conducted as part of a Natural Resource Damage Assessment (2011-2014) and follow-on studies were performed between 2016-2018 with support from the Gulf of Mexico Research Initiative. Ultrasound was used to evaluate the dolphins’ pulmonary health, including the presence/absence of pleural effusion, nodules, masses, consolidation, and alveolar interstitial syndrome (AIS). When present, AIS was further graded by severity (mild, moderate, or severe) and distribution. Based on the presence and severity of abnormalities, each dolphin was given an overall lung disease score (normal, mild, moderate, or severe). Normal to mild scores were considered within expected limits for a wild population, therefore the prevalence of normal-mild versus moderate-severe scores was compared between the oiled and unoiled sites. Separate analyses were conducted for dolphins alive in 2010 (and in BB, presumably exposed to DWH oil), and those born after 2010. For the dolphins alive in 2010, temporal trends were also examined using generalized additive models (GAMs). Results showed a strong difference (p=0.000357) in moderate to severe lung disease between the two sites for dolphins alive in 2010, but no significant difference (p=0.6745) between the sites for dolphins born after 2010. In BB dolphins, the prevalence of moderate to severe lung disease did not decrease in the years after the spill, and in fact, potentially worsened (p=0.0644 for trend over years), with the highest prevalence (0.61) being in 2018. Moderate to severe AIS remained a persistent finding in BB dolphins, and several animals had a pattern of AIS that was more severe ventrally than dorsally, with evidence of chronic, progressive disease states.

From the Triage to the Intermediate Area: A Simple and Fast Model for COVID-19 in the Emergency Department.

Introduction: The early identification of patients with SARS-CoV-2 infection is still a real challenge for emergency departments (ED). First, we aimed to develop a score, based on the use of the lung ultrasonography (LUS), in addition to the pre-triage interview, to correctly address patients; second, we aimed to prove the usefulness of a three-path organization (COVID-19, not-COVID-19 and intermediate) compared to a two-path organization (COVID-19, non-COVID-19). Methods: We retrospectively analysed 292 patients admitted to our ED from 10 April to 15 April 2020, with a definite diagnosis of positivity (93 COVID-19 patients) or negativity (179 not-COVID-19 patients) for SARS-COV-2 infection. Using a logistic regression, we found a set of predictors for infection selected from the pre-triage interview items and the LUS findings, which contribute with a different weight to the final score. Then, we compared the organization of two different pathways. Results: The most informative factors for classifying the patient are known nasopharyngeal swab positivity, close contact with a COVID-19 patient, fever associated with respiratory symptoms, respiratory failure, anosmia or dysgeusia, and the ultrasound criteria of diffuse alveolar interstitial syndrome, absence of B-lines and presence of pleural effusion. Their sensitivity, specificity, accuracy, and AUC-ROC are, respectively, 0.83, 0.81, 0.82 and 0.81. The most significant difference between the two pathways is the percentage of not-COVID-19 patients assigned to the COVID-19 area, that is, 10.6% (19/179) in the three-path organization, and 18.9% (34/179) in the two-path organization (p = 0.037). Conclusions: Our study suggests the possibility to use a score based on the pre-triage interview and the LUS findings to correctly manage the patients admitted to the ED, and the importance of an intermediate area to limit the spread of SARS-CoV-2 in the ED and, as a consequence, in the hospital.

The Application of Pulmonary Ultrasound in Neonatal Ventilator-Associated Pneumonia.

This study explored the application value of lung ultrasound (LUS) in neonatal ventilator-associated pneumonia (NVAP). In this study, 122 newborns suspected of NVAP were treated in the NICU of Liaocheng People’s Hospital between July 1, 2020, and July 1, 2021. Of these, 115 were clinically diagnosed with NVAP. The diagnostic value of LUS for NVAP was determined by comparing the different signs of LUS and chest X-ray (CXR). The confirmed cases were divided into the failure and success groups according to the first ventilator weaning test results. The consistency between the results of LUS and CXR and the actual test results was compared between the two groups. Before treatment, the LUS findings of the confirmed cases showed a lung consolidation with air bronchogram sign (111/115), alveolar-interstitial syndrome (113/115), pleural effusion (12/115), pleural line abnormalities (114/115), and lung pulse (15/115). CXR showed 109 cases of pneumonia. Taking the clinical diagnosis of VAP as the gold standard, the lung consolidation with air bronchogram sign on LUS had a higher sensitivity, specificity, and accuracy for the diagnosis of NVAP than those of other LUS and CXR findings and showed better consistency with the clinical diagnosis (AUC = 0.983, kappa value = 0.761, p < 0.05). After treatment, the 115 cases were divided into two groups according to the results of the first weaning from ventilation: the failed group (19 cases) and the successful group (96 cases). The lung consolidation with air bronchogram sign was used as the positive diagnostic standard of ultrasound. The sensitivity and specificity of LUS (94.7 and 89.6%, respectively) in evaluating the outcome of weaning from the ventilator of pneumonia were higher than those of CXR (73.7 and 84.4%, respectively). Additionally, the consistency of the LUS findings with the weaning results was higher than that of CXR (AUC = 0.922, kappa value = 0.709, p < 0.05). Therefore, compared with CXR, LUS has a higher value in diagnosing NVAP and can better predict the results of the ventilator off-line test. LUS can replace CXR as the first imaging examination for NVAP.

Applications of Ultrasonography in Respiratory Intensive Care

Emerging evidence suggests that ultrasonography of lung is a fast, inexpensive, widely available bed-side diagnostic tool which is useful for quick and early diagnosis of respiratory diseases. It is useful in the differential diagnosis of pulmonary infiltrates and has good accuracy in identifying consolidation and alveolar-interstitial syndrome. This technique can also be useful in the immediate evaluation of patients with dyspnoea or acute respiratory failure in the respiratory intensive care unit and helps in monitoring treatment response. Ultrasonography of lung has also been found to be useful in the diagnosis of pulmonary embolism, traumatic lung contusion and lung consolidation as well. There is a need for developing specific guidelines for establishing the standards of training and education regarding lung ultrasonography in India.

Role of Point of care ultrasound of lungs at pulmonology department of Gajju Khan Medical College, Swabi.

Objective: To evaluate the usefulness of Point of care Lung Ultrasound at Pulmonology Department Gajju Khan Medical College Swabi. Study Design: Cross Sectional study. Setting: Department of Pulmonology, Gajju Khan Medical College, Swabi. Period: March 2019 to December 2019. Material &amp; Methods: All the patients presented to OPD meeting inclusion and exclusion criteria were included, patients were selected by consecutive non-probability sampling technique. Results: Total of 139 patients were included in our study mean age was 50.40 years, range 21-93 years and standard deviation was ±18.257. Eighty one patients had Pleural Effusion, thirteen had pneumonia and 45 patients had diffuse alveolar-interstitial syndrome. Diagnostic thoracocentesis were performed on first attempt in all patients of pleural effusions without any complication. Conclusion: Our study concluded that Point of care lung Ultrasound is a useful strategy both for diagnosis and intervention of pulmonary patients at a resource limited areas.

Ultrasound Lung Image under Artificial Intelligence Algorithm in Diagnosis of Neonatal Respiratory Distress Syndrome.

In order to analyze the application of ultrasonic lung imaging diagnosis model based on artificial intelligence algorithm in neonatal respiratory distress syndrome (NRDS), an ultrasonic lung imaging diagnosis model based on a deep residual network (DRN) was proposed. In this study, 90 premature infants in the hospital were selected as the research object and divided into the experimental group (45 cases) and control group (45 cases) according to whether or not they have NRDS. DRN was compared with the deep residual network (DRWSR) based on wavelet domain, deep residual network detection with normalization framework (Fisher-DRN), and distorted image edge detection preprocessor (DIEDP). Then, it was applied to the diagnosis of NRDS. The clinical data and ultrasound imaging results of infants with NRDS and ordinary premature infants were compared. The results showed that the gestational age, birth weight, and Apgar scores of the NRDS group were remarkably lower than those of ordinary children (P < 0.05). In addition, the segmentation accuracy, image feature extraction accuracy, algorithm convergence, and time loss of the DRN algorithm were better than the other three algorithms, and the differences were considerable (P < 0.05). In children with NRDS, the positive rate of abnormal pleural line, disappearance of A line, appearance of B line, and alveolar interstitial syndrome (AIS) test in the results of lung ultrasound examination in children with NRDS were all 100%. The lung consolidation became 70.8%, and the white lung-like change was 50.1%, both of which were higher than those of ordinary preterm infants, and the differences were considerable (P < 0.05). The diagnostic model of this study predicted that the AUC area of grade 1-2, grade 2-3, and grade 3-4 NRDS were 0.962, 0.881, and 0.902, respectively. To sum up, the ultrasound lung imaging diagnosis model based on the DRN algorithm had good diagnostic performance in children with NRDS and can provide useful information for clinical NRDS diagnosis and treatment.

Value Comparison of Iterative Reconstruction Algorithm-Based Chest CT and Ultrasound in the Diagnosis of Community-Acquired Pneumonia in Children

This study aimed to explore the diagnostic value of chest computed tomography (CT) based on adaptive statistical iterative reconstruction (ASiR) in the optimal weight range for children with community-acquired pneumonia (CAP) and find the differences between chest CT and ultrasound in the diagnosis of CAP. 106 children who were diagnosed as CAP were selected as the research objects. All objects underwent CT and ultrasound scans to measure the noise of CT images after iterative reconstruction and the contrast-to-noise ratio (CNR) of the thoracic aorta and the back muscles. The correlation between ASiR weight, noise, and CNR was analyzed and compared further. In addition, the differences in imaging manifestations of lung consolidation, abnormal pleural line, alveolar interstitial syndrome, and pleural effusion were observed under the ultrasound and CT scans of the patients. The sensitivity, specificity, positive predicted value (PV), and negative PV of the CT scan and ultrasound were analyzed further for the diagnosis of CAP in children. The results showed that ASiR weight and image noise were extremely and negatively correlated ( P &lt; 0.001 ) and that CNR and ASiR weight were extremely and positively correlated ( P &lt; 0.001 ). 40–60% of ASiR image noise was in the middle position, and the muscle space and subcutaneous fat in CT images were clearer when ASiR was at 40% and 60%. 60.38% of children were diagnosed as CAP. The proportions of children with lung consolidation, interstitial changes, pleural effusion, and atelectasis after ultrasound and CT examination were not greatly different ( P &gt; 0.05 ). After ASiR, the sensitivity of CT in detecting the abnormal pleural line + B-line/consolidation feature was the highest, 93.75%. The results of ultrasound diagnosis were consistent with those of chest CT diagnosis ( P &lt; 0.01 ). This indicated that the sensitivity, specificity, positive PV, and negative PV of ASiR-based chest CT in the diagnosis of CAP were close to those of ultrasound.

Role of lung ultrasound in diagnosing and differentiating transient tachypnea of the newborn and respiratory distress syndrome in preterm neonates.

AimTo evaluate the accuracy of lung ultrasound in diagnosing and differentiating transient tachypnea of the newborn and respiratory distress syndrome in preterm neonates.Material and methodsThis was a single-center study. From January 2020 to June 2021. A total of 100 preterm neonates, admitted to the neonatal intensive care unit with symptoms of respiratory distress within six hours of birth, including 50 diagnosed with transient tachypnea of the newborn and 50 with respiratory distress syndrome on the basis of clinical examination, laboratory testing, chest X-rays, were recruited in the study. Lung ultrasound was performed in each neonate by a senior radiologist who was blinded to the clinical diagnosis. Lung ultrasound findings in both conditions were analyzed and compared.ResultsPulmonary edema manifesting as alveolar-interstitial syndrome, double lung point sign and less commonly as white out lungs in the absence of consolidation has 100% sensitivity and specificity in diagnosing transient tachypnea of the newborn. A combination of three signs of consolidation with air or fluid bronchograms, white out lungs and absent spared areas has 100% sensitivity and specificity for diagnosing respiratory distress syndrome. Double lung point sign was seen only in infants suffering from transient tachypnea of the newborn and consolidation with air or fluid bronchograms only in cases of respiratory distress syndrome.ConclusionLung ultrasound can accurately diagnose and reliably differentiate transient tachypnea of the newborn and respiratory distress syndrome in preterm neonates. It has advantages that cannot be replicated by chest radiography. Lung ultrasound may be used as an initial screening tool.

353 Reliability of Nurse-Performed Lung Ultrasonography of Suspected COVID-19 Patients at the Emergency Department Triage: A Single Center Study

Point-of-care lung ultrasound is now considered a valuable tool in the emergency department to evaluate patients with respiratory complaints. It is very reliable in detecting artifacts associated with alveolar-interstitial syndrome - a common feature seen in patients with pneumonia, pulmonary edema and more recently, COVID-19. The aim of this study was to determine the reliability of emergency department nurses to interpret point-of-care lung ultrasound artifacts suggestive of COVID-19 respiratory disease at the triage.

Medical Image Enhancement Algorithm for B-Mode Ultrasound Image Analysis of Neonatal Respiratory Distress Syndrome

The aim of this paper was to explore the imaging characteristics of lung B-ultrasound images under image enhancement algorithm for neonatal respiratory distress syndrome (NRDS) and the therapeutic effect of vitamin A (VA) on NDRS. 30 newborn babies with NRDS in hospital were selected as the experimental group and 30 healthy newborn babies were selected as the control group. All of them received the lung B-ultrasound based on the image enhancement algorithm under the partial differential equation (PDE). The subjects of the control group were given formula milk every day. On the basis of formula milk, the subjects of the experimental group took VA soft capsule orally once a day at noon. Oxidative stress indexes, blood gas indexes, and mechanical ventilation parameters were recorded in the subjects of the two groups. The results of 30 newborn babies with NRDS in the experimental group indicated that the images of 12 cases presented the disappearance of line A and dense or discontinuous distribution of line B; the abnormal pleural line was found in the images of 8 cases; there was lung consolidation under the pleural line, patchy hypoecho, and point-strip hyperecho in the images of 5 cases; the images of 2 cases showed alveolar edema and alveolar interstitial syndrome. Compared with before treatment, the arterial partial pressure of oxygen (PaO2) of subjects in the experimental group (87.61 ± 5.79) increased dramatically, but their arterial partial pressure of carbon dioxide (PaCO2) decreased sharply after treatment (40.07 ± 6.12), with statistically huge differences ( P &lt; 0.05 ). The respiratory rate (RR) and positive end expiratory pressure (PEEP) after treatment were greatly less than those before treatment of subjects in the experimental group ( P &lt; 0.05 ), and the difference was statistically obvious ( P &lt; 0.05 ). By comparing with before treatment, malondialdehyde (MDA) of subjects in the experimental group decreased after treatment while superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) increased considerably, with statistically marked differences ( P &lt; 0.05 ). In conclusion, lung B-ultrasound based on partial image enhancement algorithm could clearly display the imaging characteristics of NRDS, such as pleural abnormalities and alveolar stroma. Besides, VA could effectively improve the neonatal shortness of breath, which had a good clinical effect.

Lung ultrasound may support internal medicine physicians in predicting the diagnosis, bacterial etiology and favorable outcome of community-acquired pneumonia

To assess the usefulness of lung ultrasound (LUS) for identifying community-acquired pneumonia (CAP) among adult patients with suspected lower respiratory tract infection (LRTI) and for discriminating between CAP with different cultural statuses, etiologies, and outcomes. LUS was performed at internal medicine ward admission. The performance of chest X-ray (CXR) and LUS in diagnosing CAP in 410 patients with suspected LRTI was determined. All possible positive results for pneumonia on LUS were condensed into pattern 1 (consolidation + / − alveolar-interstitial syndrome) and pattern 2 (alveolar-interstitial syndrome). The performance of LUS in predicting culture-positive status, bacterial etiology, and adverse outcomes of CAP was assessed in 315 patients. The area under the receiver operating characteristic curve for diagnosing CAP by LUS was significantly higher than for diagnosis CAP by CXR (0.93 and 0.71, respectively; p < 0.001). Pattern 1 predicted CAP with bacterial and mixed bacterial and viral etiologies with positive predictive values of 99% (95% CI, 94–100%) and 97% (95% CI, 81–99%), respectively. Pattern 2 ruled out mortality with a negative predictive value of 95% (95% CI, 86–98%), respectively. In this study, LUS was useful in predicting a diagnosis of CAP, the bacterial etiology of CAP, and favorable outcome in patients with CAP.