Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric lung ultrasound. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit.
Module Goals
- List indications for performing a pediatric lung point-of-care ultrasound (POCUS).
- Describe the technique for performing lung POCUS.
- Recognize anatomical landmarks and artifacts related to lung POCUS.
- Interpret signs of a consolidation, interstitial fluid, effusion, and pneumothorax on POCUS.
- Describe the limitations of lung POCUS.
Child with Cough and Fever: Case Introduction
A 6-year-old boy presents to the emergency department complaining of cough for 3 days and fever for the last day. His fever was 103°F this morning and he received ibuprofen. He has also had abdominal and back pain. He was seen at the emergency department earlier in the day where he had a chest X-ray 6 hours prior that was interpreted as negative for consolidation and bloodwork including a complete blood count and comprehensive metabolic panel that were within normal limits. He presents with persistent cough and fever and now has increased work of breathing.
On arrival, his vital signs are:
Vital Sign | Finding |
---|---|
Temperature | 99.7 F |
Heart Rate | 138 bpm |
Blood Pressure | 102/61 |
Respiratory Rate | 32 |
Oxygen Saturation (room air) | 100% |
He is well appearing but has increased work of breathing. His lungs have decreased breath sounds and crackles over the left lung base. No wheezes are appreciated. He has mild subcostal retractions. His abdomen is soft, non-tender, and non-distended. His back is non-tender to palpation. He has normal HEENT, neck, and cardiac examinations, with the exception of tachycardia as above.
Given his presenting signs and symptoms in the setting of a recent chest X-ray that was interpreted as normal, you decide to perform a lung point-of-care ultrasound (POCUS) examination.
Case Resolution
The patient’s chest X-ray from earlier in the day was interpreted by the pediatric radiologist as negative for consolidation or other pulmonary pathology. You performed a lung POCUS with a linear, high-frequency probe and observed the following:
Video 9: A lung POCUS of the case patient’s left lower lung (affected side)
Though this child with cough, fever, focal lung findings, and respiratory distress had a negative chest X-ray performed 6 hours earlier, your POCUS evaluation identified a left lower lobe pneumonia which helped you make your diagnosis and start the appropriate treatment.
ED Course
The patient received antibiotics for pneumonia. His work of breathing increased during his emergency department visit, and he was started on high flow nasal cannula at 30 L/min with improvement in his respiratory status. He was admitted to the pediatric intensive care unit. He had a repeat chest X-ray 12 hours later that was interpreted by the pediatric radiologist as having new pleural and parenchymal changes in the left hemithorax with questionable pneumonia. He continued antibiotics, and his repeat X-ray 48 hours later showed a clear left lower lobe consolidation with pleural effusion.
Learn More…
References
- Lichtenstein DA, Lascols N, Mezière G, Gepner A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med. 2004 Feb;30(2):276-281. PMID: 14722643
- Pereda MA, Chavez MA, Hooper-Miele CC, et al. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics. 2015 Apr;135(4):714-22. PMID: 25780071
- Balk DS, Lee C, Schafer J, et al. Lung ultrasound compared to chest X-ray for diagnosis of pediatric pneumonia: A meta-analysis. Pediatr Pulmonol. 2018 Aug;53(8):1130-1139. PMID: 29696826
- Tsou PY, Chen KP, Wang YH, et al. Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta-analysis. Acad Emerg Med. 2019 Sep;26(9):1074-1088. PMID: 31211896
- Jones BP, Tay ET, Elikashvili I, et al. Feasibility and Safety of Substituting Lung Ultrasonography for Chest Radiography When Diagnosing Pneumonia in Children: A Randomized Controlled Trial. Chest. 2016 Jul;150(1):131-8. PMID: 26923626
- Milliner BHA, Tsung JW. Lung Consolidation Locations for Optimal Lung Ultrasound Scanning in Diagnosing Pediatric Pneumonia. J Ultrasound Med. 2017 Nov;36(11):2325-2328. PMID: 28586113
- Ding W, Shen Y, Yang J, He X, Zhang M. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest. 2011 Oct;140(4):859-866. PMID: 21546439
Additional Reading
- Rizvi MB, Rabiner JE. Pediatric Point-of-Care Lung Ultrasonography: A Narrative Review. West J Emerg Med. 2022 Jun 5;23(4):497-504. PMID: 35980421
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