Ultrasound in pneumonia: a valuable tool in Pediatrics and Child Respiratory

The classic diagnosis of pneumonia in the office is based on some data, obtained by asking the patient or his relatives, such as the presence of fever, cough, shortness of breath and chest pain. Then the physician will look for data in the pulmonary auscultation to support his diagnostic suspicion, normally the hearing of sounds called crackles (because they remind us of the crackling of flames) in the affected area.

But these data are not always obtained, nor are they exclusive to pneumonia, and auscultation can be confusing. In our environment, it is usual to request a chest X-ray to see and verify the diagnosis and the extent of the pneumonia.

But the request for X-rays is not a perfect solution because it generates several problems.

What problems are generated with the request for X-rays?

  • The delay in the diagnosis caused by moving the patient to perform the X-ray. in the diagnosis to perform the X-ray.
  • The radiation received by a patient with a growing organism such as a child.
  • The excessive request for X-rays due to the physician’s concern not to make a wrong diagnosis; thus, a study in the USA showed that only 8.6% of patients who were requested a chest X-ray had pneumonia.
  • The interpretation of the X-ray by a physician who is not a radiologist, and thus some pneumonias -especially those located behind the heart- may not be identified as such by the requesting physician, since if the chest X-ray is compared with the chest CT, the sensitivity of the former is only 65% of the cases.
  • If the patient’s evolution is not adequate, it will be necessary to consider whether or not a second X-ray with the corresponding irradiation is necessary.
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Chest ultrasound is gaining ground for the study of pneumonia because it solves most of the problems raised, since it is a harmless method, which can be performed at the patient’s bedside and repeated as many times as desired; it has a sensitivity for pneumonias similar, and even higher, than that of radiography.

When in pneumonia the air in the lung is replaced by inflammatory exudate, if it is in contact with the pleura, as occurs in 98% of pneumonias, a series of ultrasound images are visualized that make it possible to detect the pneumonia, its extension and to assess whether there is associated pleural effusion (which, if small, is not detected in the X-ray).

Ultrasound signs of pneumonia

  • Lines B+ absence of pleural sliding with irregularity of the pleural line.
  • Pattern A in one hemithorax, pattern B in the other.
  • Pattern C (consolidation): also called hepatization.
  • Dynamic air bronchogram.
  • Tearing sign.

For all these reasons, we consider that it is time for more ultrasound scans and less radiographies for the evaluation of pneumonias.