Ultrasound of the Week #033

Case:

An 8 year old male presented with 48 hours of vomiting, fever and abdominal pain.  The abdominal pain was in both flanks and worse on vomiting/coughing.  He had had coryzal symptoms & cough 2 weeks ago (as did brothers at home) and then recovered.  He had been tested for covid and this had been negative.  He had a slight cough with no respiratory distress nor upper respiratory symptoms.  He was drinking well and passing good amounts of urine.

SpO2 99%, RR 22.

A bedside lung ultrasound was performed showing the following:

Question: What is seen here and what is the diagnosis?

R4
R6

Answer:

This shows consolidation with air bronchograms and a ‘shred sign’, the irregular border seen here between consolidated and aerated lung.  Some B lines can be seen emanating from this irregular border. 

This is pneumonia.  There are many lung ultrasound findings in pneumonia, of which here we can see B-lines (representing increased lung density – also seen in pulmonary oedema/contusion/ARDS etc), consolidation (also seen in atelectasis) and the ‘shred sign/fractal sign’ (an irregular border of superficial consolidated lung abutting deep aerated lung – this is very sensitive and specific for lung consolidation). 

This patient was discharged on oral antibiotics and safety netting advice.  No chest XR was taken.

Lung Ultrasound for Pneumonia:

Lung ultrasound is an extremely useful modality that is more sensitive and specific than chest XR for most pulmonary pathology and is gaining increasing popularity in paediatrics as it is completely free of ionising radiation, is easy to perform at the bedside and gives immediate results.  In some institutions this is becoming the first line investigation for pneumonia in paediatrics.

For more details on Lung POCUS, see Ultrasound of the Week cases #012, #016 and #017. There are also some excellent videos at 5 Minute Sono.

References:

  1. Guerra M, Crichiutti G, Pecile P, Romanello C, Busolini E, Valent F, Rosolen A. Ultrasound detection of pneumonia in febrile children with respiratory distress: a prospective study. Eur J Pediatr. 2016 Feb;175(2):163-70. doi: 10.1007/s00431-015-2611-8. Epub 2015 Aug 19. PMID: 26283293.
  2. Pereda MA, Chavez MA, Hooper-Miele CC, Gilman RH, Steinhoff MC, Ellington LE, Gross M, Price C, Tielsch JM, Checkley W. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. 2015 Apr;135(4):714-22. doi: 10.1542/peds.2014-2833. Epub 2015 Mar 16. PMID: 25780071.

Related Articles