Sir,
We are pleased that the readers [1] found our paper [2] helpful, and we fully agree with the initial part of their Letter to the Editor.
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1.
Regarding Figure 1, the apparently thicker visceral pleura, in fact, is an artefact due to reflection from the air-containing lung: The visceral pleura is completely obscured by the complete reflection of the ultrasound beam at the lung surface [3]. The parietal pleura is enhanced in a small tract (corresponding to the arrowheads) for artefacts related to respiratory movements and beam incidence.
Concerning the sonographic diagnosis of respiratory distress syndrome and transient tachypnea of the newborn: we agree that they are based on nonspecific signs of lung disease, which originate at the surface of the lung, without complete panoramic views.
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2.
We also remind the readers of the limitations in the control of various ultrasonographic technical devices, and we believe that chest radiographs are still needed for accurate diagnosis.
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3.
It is well known that scattered B-lines may be present in normal lung and in the presence of a pneumothorax the fundamental sign to observe is the absence of sliding. Anyway, in pneumothorax in infants, the absence of B-lines is particularly noticeable; hence, the emphasis on the presence of A-lines is more important.
References
Maggi M, Pirri C, Foti T et al (2014) Thoracic ultrasound in children: evidence and drawbacks. Pediatr Radiol 44. doi:10.1007/s00247-014-2901-8
Toma P, Owens CM (2013) Chest ultrasound in children: critical appraisal. Pediatr Radiol 43:1427–1434
Reuss J (2011) Pleura. In: Mathis G (ed) Chest sonography. Springer, Berlin, pp 27–54
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Tomà, P., Owens, C.M. Thoracic ultrasound in children: reply to Maggi et al. Pediatr Radiol 44, 631 (2014). https://doi.org/10.1007/s00247-014-2914-3
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DOI: https://doi.org/10.1007/s00247-014-2914-3