Department of Pediatrics, Perrino Hospital, Brindisi, Italy.
Pediatr Pulmonol. 2013 Mar;48(3):280-7. doi: 10.1002/ppul.22585. Epub 2012 May 2.
The diagnosis of community-acquired pneumonia (CAP) is based mainly on the patient's medical history and physical examination. However, in severe cases a further evaluation including chest X-ray (CXR) may be necessary. At present, lung ultrasound (LUS) is not included in the diagnostic work-up of pneumonia.
To describe the ultrasonographic appearance of CAP at presentation and during the follow-up.
A total of 102 patients with clinical signs and symptoms suggesting pneumonia, who underwent a clinically driven CXR, were evaluated by LUS on the same day. LUS signs of pneumonia included subpleural lung consolidation, B-lines, pleural line abnormalities, and pleural effusion. The diagnostic gold standard was the ex-post diagnosis of pneumonia made by two independent experienced pediatricians on the basis of clinical presentation, CXR and clinical course following British Thoracic Guidelines recommendations.
A final diagnosis of pneumonia was confirmed in 89/102 patients. LUS was positive for the diagnosis of pneumonia in 88/89 patients, whereas CXR was positive in 81/89. Only one patient with normal LUS examination had an abnormal CXR, whereas 8 patients with normal CXR had an abnormal LUS. LUS was able to detect pleural effusion resulting from complicated pneumonia in 16 cases, whereas CXR detected pleural effusion in 3 cases.
LUS is a simple and reliable imaging tool, not inferior to CXR in identifying pleuro-pulmonary alterations in children with suspected pneumonia. During the course of the disease, LUS allows a radiation-free follow-up of these abnormalities.
社区获得性肺炎（CAP）的诊断主要基于患者的病史和体格检查。然而，在严重的情况下，可能需要进一步评估，包括胸部 X 光（CXR）。目前，肺部超声（LUS）并未纳入肺炎的诊断程序中。
描述 CAP 在发病时和随访期间的超声表现。
共纳入 102 例有临床症状和体征提示肺炎的患者，这些患者在同一天接受了临床驱动的 CXR 检查，并进行了 LUS 评估。肺炎的 LUS 征象包括胸膜下肺实变、B 线、胸膜线异常和胸腔积液。肺炎的诊断金标准是根据英国胸科协会指南的推荐，通过两位经验丰富的儿科医生基于临床表现、CXR 和临床病程进行的肺炎后诊断。
89/102 例患者最终被确诊为肺炎。LUS 对肺炎的诊断阳性率为 88/89 例，而 CXR 阳性率为 81/89 例。只有 1 例 LUS 检查正常的患者 CXR 异常，而 8 例 CXR 正常的患者 LUS 异常。LUS 能够检测出 16 例合并性肺炎的胸腔积液，而 CXR 仅检测出 3 例胸腔积液。
LUS 是一种简单可靠的影像学工具，在识别疑似肺炎儿童的胸膜-肺部改变方面，与 CXR 一样有效。在疾病过程中，LUS 可实现这些异常的无辐射随访。
