Ultrasound Examination of the Lungs in the Diagnosis of Pneumonia in Children

Aim. To present current data on the characterization, methodology, and use of lung ultrasound (LUS) in the diagnosis of pneumonia in children.

Key points. Respiratory pathology is most common in childhood due to the peculiarities of immunity and structure of the respiratory tract. Pneumonia is a not uncommon disease of the lower respiratory tract in children, requiring quick, accurate and easy to perform diagnosis, as well as correct and timely treatment. Recently, lung ultrasound examination has been gaining popularity as a tool for diagnosing diseases of the lower respiratory tract, including pneumonias. It was widely used during the COVID-19 pandemic, when there were a lot of patients. The advantages of this method are the ease of the procedure, the speed of obtaining results, the absence of ionizing radiation and the non-invasiveness of the study. Ultrasound allows for a real-time assessment of the lung tissue lesion pattern. Also, an ultrasound examination lets the child stay with their mother and keep calm during the diagnostic procedure, preventing stress. Numerous trials demonstrated high specificity and sensitivity of this diagnostic method. Results of the common and more time-consuming diagnostic methods, such as lung CT and lung X-ray, have been compared with ultrasonographic results. With lung ultrasound, the possibility of dynamic patient monitoring is opened up without the fear of receiving unnecessary radiation exposure. The review presents data on the gaining popularity of LUS, its sensitivity and specificity, the technique of the study, as well as characteristic signs of pulmonary lesions in pneumonia.

Conclusion. Lung ultrasound as a tool for pneumonia diagnostics is widely used abroad and has been included in pneumonia management protocols. Ease-of-use and safety for patients facilitate the introduction and application of this diagnostic method in paediatric inpatient units; later, it can be used in outpatient settings as well. Multidisciplinary approach to the diagnosis of pneumonia contributes to the acceleration of the correct diagnosis and the beginning of adequate therapy.

1. Sansone F., Attanasi M., Di Filippo P., Sferrazza Papa G.F. et al. Usefulness of lung ultrasound in paediatric respiratory diseases. Diagnostics. 2021;11(10):1783. DOI: 10.3390/diagnostics11101783

2. Balk D.S., Lee C., Schafer J., Welwarth J. et al. Lung ultrasound compared to chest X-ray for diagnosis of pediatric pneumonia: a meta-analysis. Pediatr. Pulmonol. 2018;53(8):1130–9. DOI: 10.1002/ppul.24020

3. Ambroggio L., Sucharew H., Rattan M.S., O’Hara S.M. et al. Lung ultrasonography: a viable alternative to chest radiography in children with suspected pneumonia? J. Pediatr. 2016;176:93–98. e7. DOI: 10.1016/j.jpeds.2016.05.033

4. Claes A.-S., Clapuyt P., Menten R., Michoux N. et al. Performance of chest ultrasound in pediatric pneumonia. Eur. J. Radiol. 2017;88:82–7. DOI: 10.1016/j.ejrad.2016.12.032

5. Hajalioghli P., Nemati M., Saleh L.D., Fouladi D.F. Can chest computed tomography be replaced by lung ultrasonography with or without plain chest radiography in pediatric pneumonia? J. Thorac. Imaging. 2016;31(4):247–52. DOI: 10.1097/RTI.0000000000000209

6. Iorio G., Capasso M., Prisco S., De Luca G. et al. Lung ultrasound findings undetectable by chest radiography in children with community-acquired pneumonia. Ultrasound Med. Biol. 2018; 44(8):1687–93. DOI: 10.1016/j.ultrasmedbio.2018.04.007

7. Yan J.-H., Yu N., Wang Y.-H., Gao Y.-B. et al. Lung ultrasound vs chest radiography in the diagnosis of children pneumonia: systematic evidence. Medicine. 2020;99(50):e23671. DOI: 10.1097/MD.0000000000023671

8. Lissaman C., Kanjanauptom P., Ong C., Tessaro M. et al. Prospective observational study of point-of-care ultrasound for diagnosing pneumonia. Arch. Dis. Child. 2019;104(1):12–18. DOI: 10.1136/archdischild-2017-314496

9. Man S.C., Fufezan O., Sas V., Schnell C. Performance of lung ultrasonography for the diagnosis of community acquired pneumonia in hospitalized children. Med. Ultrason. 2017;19(3):276–81. DOI: 10.11152/mu-1027

10. Stadler J.A.M., Andronikou S., Zar H.J. Lung ultrasound for the diagnosis of community-acquired pneumonia in children. Pediatr. Radiol. 2017;47(11):1412–19. DOI: 10.1007/s00247-017-3910-1

11. Tripathi S., Ganatra H., Martinez E., Mannaa M. et al. Accuracy and reliability of bedside thoracic ultrasound in detecting pulmonary pathology in a heterogeneous pediatric intensive care unit population. J. Clin. Ultrasound. 2019;47(2):63–70. DOI: 10.1002/jcu.22657

12. Yadav K.K., Awasthi S., Parihar A. Lung ultrasound is comparable with chest roentgenogram for diagnosis of community-acquired pneumonia in hospitalised children. Indian J. Pediatr. 2017;84(7):499–504. DOI: 10.1007/s12098-017-2333-1

13. Samson F., Gorostiza I., González A., Landa M. et al. Prospective evaluation of clinical lung ultrasonography in the diagnosis of community-acquired pneumonia in a pediatric emergency department. Eur. J. Emerg. Med. 2018;25(1):65–70. DOI: 10.1097/MEJ.0000000000000418

14. Malla D., Rathi V., Gomber S., Upreti L. Can lung ultrasound differentiate between bacterial and viral pneumonia in children? J. Clin. Ultrasound. 2021;49(2):91–100. DOI: 10.1002/jcu.22951

15. Buonsenso D., Brancato F., Valentini P., Curatola A. et al. The use of lung ultrasound to monitor the antibiotic response of community-acquired pneumonia in children: a preliminary hypothesis. J. Ultrasound Med. 2020;39(4):817–26. DOI: 10.1002/jum.15147

16. Musolino A.M., Tomà P., Supino M.C., Scialanga B. et al. Lung ultrasound features of children with complicated and noncomplicated community acquired pneumonia: a prospective study. Pediatr. Pulmonol. 2019;54(9):1479–86. DOI: 10.1002/ppul.24426

17. Deganello A., Rafailidis V., Sellars M.E., Ntoulia A. et al. Intravenous and intracavitary use of contrast-enhanced ultrasound in the evaluation and management of complicated pediatric pneumonia. J. Ultrasound Med. 2017;36(9):1943–54. DOI: 10.1002/jum.14269

18. Gravel C.A., Monuteaux M.C., Levy J.A., Miller A.F. et al. Interrater reliability of pediatric point-of-care lung ultrasound findings. Am. J. Emerg. Med. 2019;38(1):1–6. DOI: 10.1016/j.ajem.2019.01.047

19. Safarova A.F., Kobalava Zh.D., Rachina S.A., Vatsik O.T. et al. The use of lung ultrasound in patients with COVID-19. Clinical Pharmacology and Therapy. 2020;29(2):51–5. (in Russian). DOI: 10.32756/0869-5490-2020-2-51-55

20. Copetti R., Cattarossi L. Ultrasound diagnosis of pneumonia in children. Radiol. Med. 2008;113(2):190–8. DOI: 10.1007/s11547-008-0247-8

21. Strokova L.A., Egorov E.Yu. Experience in conducting lung ultrasound in community-acquired pneumonia COVID-19. Diagnostic Radiology and Radiotherapy. 2020;11(2):99–106. (in Russian). DOI: 10.22328/2079-5343-2020-11-2-99-106

22. Toro M.S., Martínez J.L., Falcão R.V., Prata-Barbosa A. et al. Point-of-care ultrasound by the pediatrician in the diagnosis and follow-up of community-acquired pneumonia. J. Pediatr. (Rio J.). 2021;97(1):13–21. DOI: 10.1016/j.jped.2020.07.003