Neonatal and pediatric thoracic ultrasonography

Abstract

Ultrasound examination of the thorax (TUS) can be quite suitable for children because their unique thoracic anatomy provides many acoustic windows into the chest. This review article covers techniques, indications, and applications of TUS in neonates, infants, and children, including common aspects and applications, like pulmonary consolidation and atelectasis, pleural effusion and pneumothorax and main neonatal pathologies such as respiratory distress syndrome (RDS) and transitory tachypnea of the newborn (TTN).

Keywords: Artifact; Chest; Lung disease; Ultrasound.

Fig. 1

Chest ultrasound examination performed with a high-frequency linear transducer (15–7 MHz) and pulmonary setting in an adult (a) and healthy newborn (b). In b, there is a better anatomical definition of the pleural reflection (hand index finger), with evidence of multiple horizontal reverberation artifacts or A-lines (orange arrows) with some ring-down or B-lines (red arrows) intersecting the above A-lines

Fig. 2

Chest ultrasound examination performed with a high-frequency linear transducer (15–7 MHz) and pulmonary setting in a healthy newborn: the horizontal reverberation artifact, or A-line, in a normal lung surface (green arrow) is parallel to the hyperechoic “pleural line”, which is equidistant (1 2 3 4)

Fig. 3

Chest ultrasound examination performed with a high-frequency linear transducer (15–7 MHz) and pulmonary setting: multiple hyperechogenic linear structures or ring-down artifacts come from the hyperechoic pleural line (white arrow) progress caudally for several cm (orange arrows)

Fig. 4

Chest ultrasound examination performed with a high-frequency linear transducer (15–7 MHz) and pulmonary setting: small linear hyperechogenic artifacts come from the “pleural line” (white arrow) and progress caudally for a few mm as a comet tail (blue arrows)

Fig. 5

Epigastric longitudinal scan with a micro-convex transducer (8–5 MHz) and pulmonary setting, a clear detection of the hepatic left lobe with visibility of the diaphragmatic interface (white arrow) that separates the thoracic compartment with the minimal fluid component of pleural effusion (VP) and a few sub-diaphragmatic peri-hepatic fluid components referable to ascites. Epigastric longitudinal scan with a high-frequency linear transducer (15–7 MHz) and pulmonary setting, b clear detection of the hepatic left lobe with an excellent view of the diaphragmatic interface that separates the thoracic compartment with minimal fluid components of pleural effusion (blue arrowhead), pulmonary air, outlined by the presence of the pleural line in the extreme front costo-diaphragmatic recess (orange arrow), and few sub-diaphragmatic peri-hepatic fluid components referable to ascites (green arrow)

Fig. 6

Chest ultrasound examination performed with a high-frequency linear transducer (15–7 MHz) and pulmonary setting: small-sized bronchopneumonia (calliper) with blurring of the margins and subtle and irregular hypoechoic appearance that reaches the pleural line, deleting part of the normal pleural hyperechogenicity

Fig. 7

Chest ultrasound examination performed with a high-frequency linear transducer (15–7 MHz) and pulmonary setting in patient with clinical and radiological regression (15 days away) of bronchiolitis virus infections: multiple ring-down artifacts (white arrows) on the middle and posterior axillary right line scans

Fig. 8

Chest ultrasound examination performed with a high-frequency linear transducer (15–7 MHz) and pulmonary setting in patients with Down syndrome, inter-atrial defects, and perinatal asphyxia: geometric areas with irregular margins and some hyperechoic spots in the context (blue arrows) on the posterior axillary anatomical right site scans

Fig. 9

Chest ultrasound examination performed with a high-frequency linear transducer (15–7 MHz) and pulmonary setting in a distressed newborn: a high number of ring-downs in confluence