Lung ultrasound for the diagnosis of community-acquired pneumonia in children

Abstract

Ultrasound (US) has been proposed as an alternative first-line imaging modality to diagnose community-acquired pneumonia in children. Lung US has the potential benefits over chest radiography of being radiation free, subject to fewer regulatory requirements, relatively lower cost and with immediate bedside availability of results. However, the uptake of lung US into clinical practice has been slow and it is not yet included in clinical guidelines for community-acquired pneumonia in children. The aim of this review is to give an overview of the equipment and techniques used to perform lung US in children with suspected pneumonia and the interpretation of relevant sonographic findings. We also summarise the current evidence of diagnostic accuracy and reliability of lung US compared to alternative imaging modalities in children and critically consider the strengths and limitations of lung US for use in children presenting with suspected community-acquired pneumonia.

Keywords: Children; Community-acquired pneumonia; Lung; Pneumonia; Ultrasound.

Fig. 1

An ultrasound image from the right anterior upper lung zone in a 16-month-old girl demonstrates normal lung echo pattern with a smooth, hyperechoic pleural line, A-lines and no B-lines

Fig. 2

An ultrasound image from the left anterior lower lung zone in a 2-year-old boy who presented with symptoms of pneumonia shows multiple and confluent B-lines in a single view representing an interstitial disease pattern

Fig. 3

An ultrasound image from the right posterior upper lung zone in a 3-month-old girl hospitalised with pneumonia shows a wedge-shaped hypoechoic area of subpleural consolidation. Associated features that can be seen are air bronchograms represented by punctate hyperechoic specs within the lesion, a hypoechoic pleural line over the lesion and multiple B-lines that arise from the deep edge of the consolidation rather than from the pleura