Double Lung Point Research Articles

Lung ultrasound to predict the duration of respiratory support in newborn infants with respiratory distress.

Lung ultrasound (LU) and clinical parameters evaluated during the first postnatal hour potentially predict the length of CPAP therapy in newborns with respiratory distress. In a single-centre, prospective observational pilot study, 130 newborns ≥36 weeks gestational age were assessed using standardised LU at 30 and 60 min postnatally. Various clinical parameters were evaluated influencing CPAP duration (<1 vs. ≥1 h) using univariate and multivariate analyses. Lung ultrasound score >5, FiO2 > 0.21 and respiratory acidosis 30 min postnatally were associated with CPAP ≥1 h. Our model showed good diagnostic quality (ROC AUC = 0.87) and was confirmed by classification and regression tree (CART) analysis. Additional LU findings like double lung point and pleural line abnormalities were frequently observed, with good interrater reliability for LU interpretation (ICC = 0.76-0.77). Newborns with postnatal respiratory distress at risk for prolonged CPAP therapy can be identified based on specific LU and clinical parameters assessed 30 min postnatally. Despite the need for validation in an independent sample, these findings may lay the groundwork for a prediction tool. LU proved feasible and reliable for assessing respiratory status in this population, highlighting potential utility in clinical practice.

Ultrasound Imaging in the Early Detection of Transient Tachypnoea of the Newborn: A Cross-sectional Study

Introduction: The most common cause of perinatal dyspnoea, frequently diagnosed on chest radiographs, is Transient Tachypnoea of Newborn (TTN). Lung Ultrasound (LUS) is recognised as a promising tool that has been proven in recent studies and tends to have better diagnostic capability. Aim: To describe the sonographic features of TTN and assess their clinical importance in early diagnosis. Materials and Methods: This cross-sectional hospital-based study was conducted at Department of Radiology, AJ Institute of Medical Sciences and Research Centre, Mangaluru, Karnataka, India, from November 2020 to May 2022. Newborns with tachypnoea admitted to the Neonatal Intensive Care Unit (NICU) were enrolled in this study. In a stable state, the infants were placed in supine, lateral, and prone positions for the ultrasound scan. LUS was performed on a total of 94 infants. Along with ultrasound, a chest radiograph was also taken. Follow-up LUS was performed on days 2, 3, and on the day of discharge from the NICU. The sonographic findings of TTN were evaluated using Pearson’s Chi-squared test. A p-value of &lt;0.05 was considered statistically significant. Results: Based on clinical manifestations, chest radiograph, and LUS, 60 newborns were diagnosed with TTN, and 34 had Respiratory Distress Syndrome (RDS). Out of the 60 newborns, the gestational age ranged from 32 weeks to 40 weeks, with a mean of 38 weeks + four days. Double Lung Point (DLP) was noted in 41 newborns with TTN, which showed a sensitivity and specificity of 68% and 100%, respectively, with a positive predictive value of 100%. Conclusion: The LUS could be widely used in the NICU as the first line of screening for the primary diagnosis of TTN and for early initiation of treatment accordingly.

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.&#x0D; 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.&#x0D; 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.&#x0D; 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.

ACCURACY OF LUNG ULTRASOUND TO DIAGNOSE TRANSIENT TACHYPNEA OF NEWBORN

Objective: To find out the accuracy of lung ultrasound to diagnose transient tachypnea in neonates&#x0D; &#x0D; Methodology: Cross-sectional study at Neonatology Department, Sadiq Abbasi (Civil) Hospital Bahawalpur from January 2019 to October 2022 and comprised of neonates diagnosed as transient tachypnea of newborn admitted and were divided into 2 groups based on Chest radiograph findings comparable to each other in demographics. Lung Ultrasonography examinations were performed in all patients in a peaceful condition. Each lung was split up in three zones bounded by anterior axillary and posterior axillary lines as anterior, posterior and lateral. Lung Ultrasonography results compared with CXR findings. &#x0D; Results: Out of 148, Lung Ultrasonography diagnosed transient tachypnea of newborn in 74% while Chest radiograph was suggestive in 39% however, Lung Ultrasonography was also diagnosed i.e. 61% transient tachypnea of newborn in neonates having normal Chest radiograph examination. The commonest Lung Ultrasonography indexes of transient tachypnea of newborn were A-lines abnormalities 100%, B-lines abnormalities 94.5 %, interstitial syndromes 81.6%, white lungs 36.6%, double lung point 86.77%, consolidation 21% and pleural effusions 10%. The sensitivity of LUS to diagnose transient tachypnea of newborn was 86.5% and the sensitivity and the specificity of Double Lung Point to diagnose transient tachypnea of newborn were 92.2% and 80% respectively.&#x0D; Conclusion: Lung Ultrasonography is a noninvasive way of bedside neonatal examination. It has analytic value to diagnose lung disease in neonates but also helps in differentiation of different lung diseases with no radiation hazard.&#x0D; Keywords: Neonatology, Fetal lung fluid, transient tachypnea of newborn, Dyspnea, Neonatal Lung 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.

Evaluation of double lung point sign as a marker for transient tachypnoea of the newborn in preterm.

PurposeThe study was conducted to diagnose transient tachypnoea of the newborn (TTN) in the early stage using ultrasonography and to estimate the sensitivity and specificity of double lung point (DLP) sign in diagnosing TTN.Material and methodsThe study population included premature neonates with respiratory distress, admitted in the neonatal intensive care unit from December 2017 to June 2019, who fulfilled the inclusion criteria. A total of 100 patients were included in the study, and they underwent lung ultrasonography within 6 hours of birth. Inclusion criteria were as follows: preterm babies born < 37 weeks of gestation presenting with respiratory distress within 6 hours, clinically diagnosed with TTN and other causes like respiratory distress syndrome and pneumonia. Term neonates and neonates with congenital malformations and trauma were excluded from the study. Preterms with respiratory distress were enrolled in the study. Based on the clinical findings and laboratory investigations, clinical diagnosis was made by the paediatrician. After obtaining informed consent, ultrasonography of bilateral chest was performed using a Philips HD7 XE and a Sonoscape S2 portable ultrasound machine with a linear transducer (6-12 MHz) within 6 hours of birth.ResultsThe mean gestational age was 33.0 ± 1.9 weeks. Double lung point sign was present in 55 preterm neonates in our study. It was most common in bilateral posterior lung fields. The sensitivity and specificity of DLP in diagnosing TTN was 85% and 100%, respectively.ConclusionsIt was found in our study that double lung point sign is the primary ultrasonographic characteristic of TTN, and ultrasonography can almost accurately diagnose TTN in early stages.

Use of lung ultrasound and and aEEG patterns to predict the need for mechanical ventilation and the readiness for extubation in neonates with respiratory distress

Objective. The aim of the study was to establish if lung ultrasound findings could anticipate the need for intubation and mechanical ventilation in neonates with respiratory distress and if lung ultrasound and aEEG criteria could be used in appreciation of the readiness for extubation of the neonatal patients resulting in a decrease of the rate of extubation failure. Material and method. There were analyzed the cases of 50 late preterm and early term neonates presenting with respiratory distress. Lung ultrasound was performed during the first 4 hours after delivery in all the neonates and then as clinically indicated in the case of ventilated patients. A lung ultrasound was performed in all the ventilated patients before extubation. 12 of the 25 ventilated patients were also monitored by aEEG. The decisions regarding the intubation and mechanical ventilation and the moment of extubation of the patients were taken by the clinicians in accordance with the local and international guidelines. The extubation failure was defined as the need to re-intubate the patient in the first 24 hours after the extubation. The lung ultrasound pattern was considered as normal if the image was consisting of A lines with rare B lines or ”double lung point” as in the case of the delayed absorption of fetal lung fluid and abnormal in the case of “white lung” appearance (coalescent B lines) or an image of consolidation. A normal aEEG was defined as the presence of a continuous normal voltage pattern with sleep-wake cycles present and an abnormal aEEG as either discontinuous normal voltage, burst-suppression, low voltage or flat background patterns. The lung ultrasound patterns in the first hours of life were compared between patients that needed intubation and those that did not need mechanical ventilation. The lung ultrasound and aEEG patterns before extubation were compared between the patients that did not need re-intubation and those with extubation failure. Results. An abnormal image on lung ultrasound was significantly associated with the risk of intubation (p &lt; 0.001) (sensitivity 84%, specificity 100%, positive predictive value 100% and negative predictive value 86.2%) An abnormal lung ultrasound pattern before extubation was associated with a significant risk of extubation failure (p &lt; 0.049) (sensitivity 75%, specificity 85%, positive predictive value 50%, negative predictive value 94.7%). In the case of the subset of patients in which aEEG was performed, an abnormal aEEG pattern was significantly associated with extubation failure (p &lt; 0.034) (sensitivity 100%, specificity 88%, positive predictive value 75%, negative predictive value 100%). In the case of association of the two parameters (lung ultrasound and aEEG pattern) there was again a statistically significant association between the abnormal patterns and extubation failure. Conclusions. An abnormal lung ultrasound during the first hours of life is a strong predictor for the need of intubation and mechanical ventilation in the neonates with respiratory distress. The normal lung ultrasound pattern just before extubation is predictive of a good evolution without the need for re-intubation of the patient. A normal aEEG pattern at the same time is associated also with a decreased risk of extubation failure.

Signs and lines in lung ultrasound.

Point-of-care ultrasound has become firmly established in acute and critical care settings, and is now increasingly being used as an important tool in the assessment of the lungs. In this article, we briefly describe the technique of lung ultrasound and the various lines and signs commonly encountered during sonography of the lung, namely the normally visualised A- and T-lines and the bat sign, sliding sign (power slide sign on colour Doppler), sea-shore sign, curtain sign, and the lung pulse. We have also described signs seen in various pathological conditions like B-lines seen in cases of increased lung density; the quad sign, sinusoid sign, thoracic spine sign, plankton sign and the jelly fish sign seen in pleural effusion; the stratosphere sign and the lung point sign seen in pneumothorax; the shred/fractal sign and tissue-like sign in consolidation, and the double lung point sign seen in transient tachypnoea of the newborn. With adequate and appropriate training, lung ultrasound can be effectively utilised as a point-of-care investigation.

Lung Point Sign in Ultrasound Diagnostics of Pneumothorax: Imitations and Variants.

Background Pulmonary ultrasound plays a key role in the diagnosis of pneumothorax in emergency and intensive-care medicine. The lung point sign has been generally considered a pathognomonic diagnostic sign. Recently, several other situations have been published that can mimic the lung point, as well as a few different variants of the true lung point sign. Materials and Methods Based on years of monitoring the literature and collecting our database of ultrasound findings, we prepared a review of ultrasound findings mimicking the lung point sign and ultrasound variants of the true lung point sign. Results We present four imitations of the lung point sign (physiological lung point sign, pseudo-lung point sign, bleb point sign, and pleurofascial point sign) and two variants of the true lung point sign (double lung point sign and hydro point sign) documented by images and video records. Conclusions Knowledge of ultrasound imitations and variants of the lung point sign may increase the reliability of pneumothorax diagnosis and may reduce the risk of performing unindicated interventions.

Double Lung Point Vs X-Ray in Transient Tachypnea of Newborn

Background: Transient tachypnea of the newborn (TTNB) is one of the most common causes of perinatal dyspnea and is traditionally diagnosed by chest x-ray. Lung ultrasound is an upcoming tool which is being proved in recent studies to have a better diagnostic capability with the main characteristic feature being the Double Lung Point. Aims &amp; objectives: To define ultrasonographic appearance of TTNB, evaluate its clinical relevance for early diagnosis and compare the outcome with xray and to assess the diagnostic ability of Double lung point.Subjects and Methods:All newborns presenting with tachypnea within 4 hours of life in 1 ½ years of study period. (November 2017-May 2019) were enrolled for study. Methods of collection of data: All newborns fulfilling the inclusion criteria were included as study subjects, At same time CHEST XRAY and LUS were done. Statistical analysis: Fisher’s exact test was used as test of significance for qualitative data. Continuous data was represented as mean and standard deviation. Mann Whitney U test and Kruskul-wallis test was used for subgroup analysis. P value of &lt;0.05 was considered as statistically significant.Result:In study period of 1 ½ years 99 cases which were admitted in NICU with respiratory distress meeting the criteria were included. 60 cases were diagnosed to have TTNB, 34 RDS &amp; 5 Pneumonia. Chest xray and Lung ultrasound (LUS) of these 60 TTNB cases were compared . LUS of TTNB and other cases was also compared for presence of double lung point (DLP). The sensitivity &amp; specificity of DLP in diagnosis of TTNB was noted to be 68 % &amp; 100 % respectively with 100 % Positive predictive value. Thus confirming LUS to be a more reliable diagnostic tool than x-ray.Conclusion:Therefore LUS could be used widely in NICU as 1st line of diagnostic medium in diagnosis of various respiratory conditions and early initiation of treatment accordingly.

A Multicenter Lung Ultrasound Study on Transient Tachypnea of the Neonate

Background and Aim: Discordant results that demand clarification have been published on diagnostic lung ultrasound (LUS) signs of transient tachypnea of the neonate (TTN) in previous cross-sectional, single-center studies. This work was conducted to correlate clinical and imaging data in a longitudinal and multicenter fashion. Methods: Neonates with a gestational age of 34–40 weeks and presenting with TTN underwent a first LUS scan at 60–180 min of life. LUS scans were repeated every 6–12 h if signs of respiratory distress persisted. Images were qualitatively described and a LUS aeration score was calculated. Clinical data were collected during respiratory distress. Results: We enrolled 65 TTN patients. Thirty-one (47.6%) had a sharp echogenicity increase in the lower lung fields (the “double lung point” or DLP sign). On admission, there was no significant difference between patients with and without DLP in Silverman scores (4 ± 1.5 vs. 4 ± 2.1; p = 0.9) or LUS scores (7.6 ± 2.6 vs. 5.6 ± 3.8; p = 0.12); PaO₂/FiO₂ (249 ± 93 vs. 252 ± 125; p = 0.91). All initial LUS scans (performed at the onset of distress) and 99.5% of all scans showed a regular pleural line with no consolidation, with only 1 neonate showing consolidation in the follow-up scans. The Silverman and LUS scores were significantly correlated (rho = 0.27; p = 0.02). Conclusion: A regular pleural line with no consolidation is a consistent finding in TTN. The presence of a DLP is not essential for the LUS diagnosis of TTN. A semi-quantitative LUS score correlates well with the clinical course and could be useful in monitoring changes in lung aeration during TTN.

Lung ultrasound in early diagnosis of neonatal transient tachypnea and its differentiation from other causes of neonatal respiratory distress.

Transient tachypnea of the newborn (TTN) is one of the most common causes of neonatal respiratory distress (RD). However, distinguishing TTN from other causes of RD may be difficult during the first 12:24 h after birth. Lung ultrasonography (LUS) has been successfully utilized in the diagnosis and differential diagnosis of neonatal RD. This study aimed to investigate the diagnostic value of LUS for early diagnosis of TTN as well as differentiate it from other causes of neonatal RD in near and full term Egyptian neonates. LUS was performed in 65 near and full term neonates presented with RD within the first 12:24 hours of admission in NICU of Suez Canal University, Ismailia, Egypt. Among the 65 neonates included in the study, 73.8% were diagnosed to have TTN, 18.5% were diagnosed to have pneumonia, 4.6% had meconium aspiration syndrome (MAS) and 3.1% had respiratory distress syndrome (RDS). The Double lung point has 69.6% sensitivity, 100% specificity, 100% PPV and 39.1% NPV for detecting TTN. We have novel data showing a positive correlation between the degree of alveolar-interstitial syndrome (AIS) and the type of oxygen support offered to neonates diagnosed with TTN. We found LUS to be a reliable and non-invasive tool for the early diagnosis of TTN and its differentiation from other causes of neonatal RD in near and full term Egyptian neonates.

Lung Ultrasonography to Diagnose Transient Tachypnea of the Newborn.

This study explored the sensitivity and specificity of ultrasound for diagnosing transient tachypnea of the newborn (TTN). Ultrasound was performed by one export. Patients were placed in a supine, lateral recumbent, or prone position. The probe was placed perpendicular or parallel to the ribs, and each region of the lung was scanned. The scan results were compared with conventional chest radiographic results. A total of 1,358 infants were included in this study. We identified 412 cases without pulmonary diseases, 228 TTN cases, 358 respiratory distress syndrome (RDS) cases, 85 meconium aspiration syndrome (MAS) cases, 215 infectious pneumonia cases, and 60 other cases. The primary ultrasonic characteristic of TTN was pulmonary edema. "White lung" or a "compact B-line" were only observed in severe cases, whereas TTN primarily presented as pulmonary interstitial syndrome or "double lung point." Furthermore, double lung point could appear during the recovery period of severe TTN or RDS, MAS, and pneumonia. Lung consolidation with air bronchograms was not observed in TTN patients. The results showed that white lung or a compact B-line exhibited a sensitivity of 33.8%and a specificity of 91.3%in diagnosing TTN, whereas double lung point exhibited a sensitivity of 45.6%and a specificity of 94.8%in diagnosing severe TTN. Pulmonary edema, alveolar-interstitial syndrome, double lung point, white lung, and compact B-line are the primary ultrasound characteristics of TTN. Ultrasonic diagnosis of TTN based on these findings is accurate and reliable. TTN can be ruled out in the presence of lung consolidation with air bronchograms.

Double lung point in an 18-month-old child: a case report and literature review.

Double lung point is a rare sign of pneumothorax in clinical practice. In this report I presented an 18-month-old child who presented with bilateral pneumothorax. Ultrasonography examination revealed conventional lung point sign on the right and double lung point on the left side. Thoracentesis was attempted and closed thoracic drainage was performed on the right side, but no gas was drawn on the left side. Clinical implication of double lung point sign found in chest ultrasonography is that the size of pneumothorax is limited and conservative treatment is enough. To the best of our knowledge, this is the first case of double lung point identified with ultrasonography in child. The strength of the case is that the double lung point sign is supported by computed tomography (CT). Furthermore, we propose that the presence of double lung point indicates limited pneumothorax and conservative management may well be attempted.

ABSTRACT 445

Background and aims: The diagnosis of transient tachypnea of the newborn (TTN) is usually based on clinical manifestations.arterial blood gas analysis and chest x-ray.Lung uhrasounds are typically not included in the diagnostic work-up of neonatal TTN. Recently.uhrasounds have been used extensively and successfully in the diagnosis of many kinds of lung diseases.But few studies have addressed neonatal TTN. Aims: To evaluate the value of lung ultrasound to diagnose TTN. Methods: From May to Dec.2012,70 infants from NICU of Bayi Children’S Hospital Affiliated to General Hospital of Beijing Military Command,were divided into 2 groups.The study group consisted of 40 newborn infants diagnosed TFN by clinical manifestations.arterial blood gas analysis and chest X-ray. while the eontrol group consisted of 30 neonates without any lung diseases.In a quiet state,the infants were positioned in supine,side or prone.The lung field was divided into 3 areas by the anterior axillary line and posterior axillary line.The regions of the bilateral lung were scanned by the probe which was vertical or parallel with the ribs,then compared the results with conven· tional chest X-ray findings. Results: The common ultrasound signs of TTN ncluded double lung point.alveolar-interstial syndrome or bilateral white lung,pleural line abnormalities,A-line disappearance,pleural effusion and comet-tail artifacts,etc,without lung consolidation or air bronehogram.The double lung point was present in all infants with TTN,the sensitivity and specificity of which was all 1 00%for the diagnosis of TTN. Conclusions: Lung uhrasonography is reliable for the diagnosis of TTN and it is worth carrying out in NICU.

Unusual new signs of pneumothorax at lung ultrasound

BackgroundThe diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology. The conventional lung ultrasound examination consists of a step-by-step procedure targeted towards the detection of four classic ultrasound signs, the lung sliding, the B lines, the lung point and the lung pulse. In most cases, a combination of these signs allows a safe diagnosis of pneumothorax. However, the widespread application of sonographic methodology in clinical practice has brought out unusual cases which raise new sonographic signs. The purpose of this article was to introduce some of these new signs that are described after the analysis of unusual and complex cases encountered during the clinical daily practice in an emergency department.FindingsThe double lung point consists of the alternating patterns of sliding and non-sliding lung intermittently appearing at the two opposite sides of the scan. The septate pneumothorax allows B lines and lung pulse to be still visible in a condition of pneumothorax with absent sliding. In hydropneumothorax, the air/fluid border is imaged by lung ultrasound as the interposition between an anechoic space and a non-sliding A-pattern, a sign that may be named hydro-point.ConclusionsIn bedside lung ultrasound, the operator should be aware and interpret double lung point, septate pneumothorax and hydro-point. The conventional diagnostic protocol of bedside lung ultrasound for pneumothorax should be occasionally adapted to such complex cases.

Value of lung ultrasound on diagnosing transient tachypnea of newborn

Objective To evaluate the diagnostic value of lung ultrasonography for transient tachypnea of newborn (TTN). Methods From January to December 2014, a total of 1 358 children were hospitalized in the Neonatal Intensive Care Center and underwent lung ultrasonography at the Bayi Children's Hospital, Beijing Military General Hospital.According to the patients' medical histories, clinical presentations, arterial blood gas analysis, chest X-ray examinations, and lung ultrasound examinations, there were 412 cases of patients without pulmonary lesions, 228 cases of TTN, 358 cases of respiratory distress syndrome (RDS), 85 cases of meconium aspiration syndrome (MAS), 215 cases of infectious pneumonia, and 60 other cases at the time of hospital admission.In a resting state, the patients were placed in a supine, lateral recumbent or prone position.By using the anterior and posterior axillary lines as boundaries, the lung was divided into 3 regions: anterior, lateral, and posterior.The probe was perpendicular or parallel to the ribs, and each region of both sides of the lung was scanned.The scan results were compared to the conventional chest X-ray results. Results The main ultrasonic characteristics of TTN was pulmonary edema.In severe cases, the ultrasound showed a white lung or compact B-line.Compact B-line had 100.0% sensitivity and 95.3% specificity for diagnosing severe TTN.Mild TTN presented as pulmonary interstitial syndrome or double lung point.Double lung point might appear during the recovery period of mild TTN or other diseases, such as RDS, MAS, and pneumonia, among others.Lung consolidation and air bronchogram were not observed in patients with TTN.Pleural effusion might occur in a variety of lung diseases, and pleural line abnormality, A-line disappearance, and B-line or pulmonary interstitial syndrome were common ultrasonic manifestations of a variety of lung diseases. Conclusions Ultrasonic diagnosis of TTN, mainly based on pulmonary edema without lung consolidation and air bronchogram, is accuracy and reliable; however, double lung point is not a specific sign of TTN, whereas the identification of a white lung and compact B-line is a sensitive and specific sign of severe TTN. Key words: Transient tachypnea; Lung ultrasound; Infant, newborn

The double lung point: an unusual sonographic sign of juvenile spontaneous pneumothorax

Lung ultrasound is extremely useful in the bedside diagnosis of pneumothorax. The lung point, which is the sonographic demonstration of the point on the chest wall where the pleural layers adhere again, represents the limit of the pneumothorax extension and allows estimation of its volume. This sonographic sign is not only highly accurate in ruling-in pneumothorax but also helps the clinician in deciding whether to place a chest tube. We report a case of a young patient with spontaneous pneumothorax showing a double lung point. The double lung point is explained by the fact that the air is not free in the pleural space but forms a bulla surrounded by adherent pleural layers. In this case, the ultrasound examination could be confounding and the clinician should be aware of it. This phenomenon is quite rare in the juvenile spontaneous pneumothorax, being more frequent in case of secondary pneumothorax.