European Journal of Pediatrics

, 170:1427 | Cite as

Lung ultrasound in bronchiolitis: comparison with chest X-ray

  • Vito Antonio CaiuloEmail author
  • Luna Gargani
  • Silvana Caiulo
  • Andrea Fisicaro
  • Fulvio Moramarco
  • Giuseppe Latini
  • Eugenio Picano
Original Paper


The diagnosis of bronchiolitis 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 bronchiolitis. This study aimed to compare the diagnostic accuracy of LUS and CXR in children with bronchiolitis, and to evaluate the correlation between clinical and ultrasound findings. Only patients with a diagnosis of bronchiolitis, who had undergone a CXR, were enrolled in the study. Fifty-two infants underwent LUS and CXR. LUS was also performed in 52 infants without clinical signs of bronchiolitis. LUS was positive for the diagnosis of bronchiolitis in 47/52 patients, whereas CXR was positive in 38/52. All patients with normal LUS examination had a normal CXR, whereas nine patients with normal CXR had abnormal LUS. In these patients, the clinical course was consistent with bronchiolitis. We found that LUS is a simple and reliable tool for the diagnosis and follow-up of bronchiolitis. It is more reliable than CXR, can be easily repeated at the patient’s bedside, and carries no risk of irradiation. In some patients with bronchiolitis, LUS is able to identify lung abnormalities not revealed by CXR. Furthermore, there is a good correlation between clinical and ultrasound findings. Given the short time needed to get a US report, this technique could become the routine imaging modality for patients with bronchiolitis.


Lung ultrasound Bronchiolitis B-lines Chest X-ray 



Lung ultrasound




Chest X-ray


Conflict of interest

None of the authors has declared any conflict of interest.


  1. 1.
    Ait-Ali L, Andreassi MG, Foffa I, Spadoni I, Vano E, Picano E (2010) Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart 96(4):269–274PubMedCrossRefGoogle Scholar
  2. 2.
    Andreassi MG (2009) Radiation risk from pediatric cardiac catheterization: friendly fire on children with congenital heart disease. Circulation 120(19):1847–1849PubMedCrossRefGoogle Scholar
  3. 3.
    Bedetti G, Gargani L, Corbisiero A et al (2006) Evaluation of ultrasound lung comets by hand-held echocardiography. Cardiovasc Ultrasound 4:34PubMedCrossRefGoogle Scholar
  4. 4.
    Bordley WC, Viswanathan M, King VJ et al (2004) Diagnosis and testing in bronchiolitis. A systematic review. Arch Pediatr Adolesc Med 158(2):119–126PubMedCrossRefGoogle Scholar
  5. 5.
    Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ (2010) Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med 183(3):341–7PubMedCrossRefGoogle Scholar
  6. 6.
    Brenner DJ, Hall EJ (2007) Current concepts—computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRefGoogle Scholar
  7. 7.
    British Thoracic Society Standards of Care Committee (2002) British thoracic society guidelines for the management of community acquired pneumonia in childhood. Thorax 57(Suppl 1):i1–i24Google Scholar
  8. 8.
    Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation (2006) Nuclear and Radiation Studies Board, Division on Earth and Life Studies, National Research Council of the National Academies. In: Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. National Academy Press, Washington, DCGoogle Scholar
  9. 9.
    Copetti R, Cattarossi L (2007) The ‘double lung point’: an ultrasound sign diagnostic of transient tachypnea of the newborn. Neonatology 91:203–209PubMedCrossRefGoogle Scholar
  10. 10.
    Copetti R, Cattarossi L (2008) Ultrasound diagnosis of pneumonia in children. Radiol Med 113:190–198PubMedCrossRefGoogle Scholar
  11. 11.
    Copetti R, Cattarossi L, Macagno F, Violino M, Furlan R (2008) LUS in respiratory distress syndrome: a useful tool for early diagnosis. Neonatology 94:52–59PubMedCrossRefGoogle Scholar
  12. 12.
    Copetti R, Soldati G, Copetti P (2008) Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound 6:16PubMedCrossRefGoogle Scholar
  13. 13.
    Emergency ultrasound guidelines (2009) Ann Emerg Med 53(4):550–570CrossRefGoogle Scholar
  14. 14.
    Gargani L, Frassi F, Soldati G, Tesorio P, Gheorghiade M, Picano E (2008) Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: a comparison with natriuretic peptides. Eur J Heart Fail 10:70–77PubMedCrossRefGoogle Scholar
  15. 15.
    Gargani L (2011) Lung ultrasound: a new tool for the cardiologist. Cardiovasc Ultrasound 9(1):6PubMedCrossRefGoogle Scholar
  16. 16.
    Lichtenstein D et al (1997) The comet-tail artifact: an ultrasound sign of alveolarinterstitial syndrome. Am J Respir Crit Care Med 156:1640–1646PubMedGoogle Scholar
  17. 17.
    Lichtenstein D, Meziere G, Biderman P et al (2000) The lung point: an ultrasound sign specific to pneumothorax. Intensive Care Med 26:1434–1440PubMedCrossRefGoogle Scholar
  18. 18.
    Lichtenstein DA, Mezière GA (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 134:117–125PubMedCrossRefGoogle Scholar
  19. 19.
    Mathis G, Blank W, Reissig A, Lechleitner P, Reuss J, Schuler A, Beckh S (2005) Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients. Chest 128:1531–1538PubMedCrossRefGoogle Scholar
  20. 20.
    Miller RW (1995) Special susceptibility of the child to certain radiation-induced cancers. Environ Health Perspect 103(suppl 6):41–44PubMedCrossRefGoogle Scholar
  21. 21.
    Picano E, Frassi F, Agricola E, Gligorova S, Gargani L, Mottola G (2006) Ultrasound lung comets: a clinically useful sign of extravascular lung water. J Am Soc Echocardiogr 19:356–363PubMedCrossRefGoogle Scholar
  22. 22.
    Reissig A, Kroegel C (2007) Sonographic diagnosis and follow-up of pneumonia: a prospective study. Respiration 74:537–547PubMedCrossRefGoogle Scholar
  23. 23.
    Shu XO, Jin F, Linet MS, Zheng W, Clemens J, Mills J, Gao YT (1994) Diagnostic X-ray and ultrasound exposure and risk of childhood cancer. Br J Cancer 70:531–536PubMedCrossRefGoogle Scholar
  24. 24.
    Subcommitte on Diagnosis and Management of Bronchiolitis (American Academy of Pediatrics) (2006) Diagnosis and management of bronchiolitis. Pediatrics 118:1774–1793CrossRefGoogle Scholar
  25. 25.
    Volpicelli G, Caramello V, Cardinale L, Mussa A, Bar F, Frascisco MF (2008) Bedside ultrasound of the lung for the monitoring of acute decompensated heart failure. Am J Emerg Med 26:585–591PubMedCrossRefGoogle Scholar
  26. 26.
    Wood DW, Downeś JJ, Locks HI (1972) A clinical score for the diagnosis of respiratory failure. Amer J Dis Child 123:227–229PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Vito Antonio Caiulo
    • 1
    Email author
  • Luna Gargani
    • 2
  • Silvana Caiulo
    • 3
  • Andrea Fisicaro
    • 3
  • Fulvio Moramarco
    • 1
  • Giuseppe Latini
    • 4
    • 5
  • Eugenio Picano
    • 2
  1. 1.Department of PediatricsPerrino HospitalBrindisiItaly
  2. 2.Institute of Clinical Physiology, National Council of Research, Division of PisaPisaItaly
  3. 3.School of MedicineSan Raffaele UniversityMilanItaly
  4. 4.Department of NeonatologyPerrino HospitalBrindisiItaly
  5. 5.Institute of Clinical Physiology, National Council of Research, Division of LecceLecceItaly

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