Skip to main content

Lung ultrasound findings in pediatric community-acquired pneumonia requiring surgical procedures: a two-center prospective study

Pediatric Radiology volume 50, pages 1560–1569 (2020)Cite this article

Abstract

Background

Lung ultrasound (US) in the evaluation of suspected pediatric pneumonia is increasingly used and has a recognized role in evaluating pleural effusions, although there are no detailed studies specifically addressing its use in the pediatric population.

Objectives

To define lung US findings of severe pediatric community-acquired pneumonia that required surgical procedures during admission.

Materials and methods

Our prospective case-control study compared lung US findings in patients ages 1 month to 17 years admitted with community-acquired pneumonia that required surgical procedures from findings those who did not. Lung US was performed at admission and always before surgical procedures. Medical treatment, laboratory and microbiological findings, chest X-ray, computed tomography scan and surgical procedures are described.

Results

One hundred twenty-one children with community-acquired pneumonia were included; of these, 23 underwent surgical intervention. Compared with the control group, children requiring a surgical procedure had a significantly higher rate of large consolidations (52.2%; 95% confidence interval [CI]: 30.6% to 73.2%), larger and complicated pleural effusions (100%; 95% CI: 85.2% to 100%), and both liquid and air bronchograms (73.9%; 95% CI: 51.6% to 89.8%).

Conclusion

Larger consolidations, larger and more complicated pleural effusions, and liquid and air bronchograms were associated with surgical treatment.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. World Health Organization (2019) Pneumonia. http://www.who.int/mediacentre/factsheets/fs331/en/index.html. Accessed 17 October 2019

  2. Rudan I, O'Brien KL, Nair H et al (2013) Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries. J Glob Health 3:010401

    Article  Google Scholar 

  3. McAllister DA, Liu L, Shi T et al (2019) Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis. Lancet Glob Health 7:e47–e57

  4. Bradley JS, Byington CL, Shah SS et al (2011) The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 53:e25–e76

    Article  Google Scholar 

  5. United Nations, Department of Economic and Social Affairs, Population Division (2015) World population prospects: the 2015 revision, key findings and advance tables. https://esa.un.org/unpd/wpp/publications/files/key_findings_wpp_2015.pdf. Accessed 12 August 2019

  6. Nair H, Simoes EA, Rudan I et al (2013) Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet 381:1380–1390

    Article  Google Scholar 

  7. Sawicki GS, Lu FL, Valim C et al (2008) Necrotising pneumonia is an increasingly detected complication of pneumonia in children. Eur Respir J 31:1285–1291

    CAS  Article  Google Scholar 

  8. Gerdung CA, Ross BC, Dicken BJ, Bjornson CL (2019) Pneumonectomy in a child with multilobar pneumatocele secondary to necrotizing pneumonia: case report and review of the literature. Case Rep Pediatr 2019:2464390

    PubMed  PubMed Central  Google Scholar 

  9. De Marco R, Accordini S, Marcon A et al (2011) Risk factors for chronic obstructive pulmonary disease in a European cohort of young adults. Am J Respir Crit Care Med 183:891–897

    Article  Google Scholar 

  10. Svanes C, Sunyer J, Plana E et al (2010) Early life origins of chronic obstructive pulmonary disease. Thorax 65:14–20

    CAS  Article  Google Scholar 

  11. Edmond K, Scott S, Korczak V et al (2012) Long term sequelae from childhood pneumonia; systematic review and meta-analysis. PLoS One 7:e31239

    CAS  Article  Google Scholar 

  12. Le Roux DM, Zar HJ (2017) Community-acquired pneumonia in children - a changing spectrum of disease. Pediatr Radiol 47:1392–1398

    Article  Google Scholar 

  13. Musolino AM, Tomà P, Supino MC et al (2019) Lung ultrasound features of children with complicated and noncomplicated community acquired pneumonia: a prospective study. Pediatr Pulmonol 54:1479–1486

    Article  Google Scholar 

  14. Buonsenso D, Curatola A, Valentini P et al (2019) Chest ultrasound findings in children with confirmed pulmonary tuberculosis in low tuberculosis incidence country. Pediatr Pulmonol 54:1348–1350

    Article  Google Scholar 

  15. Buonsenso D, Musolino AM, Gatto A et al (2019) Lung ultrasound in infants with bronchiolitis. BMC Pulm Med 19:159

    Article  Google Scholar 

  16. Supino MC, Buonsenso D, Musolino AM (2019) Correspondence on "ultrasound as diagnosis tool for grading bronchiolitis. Where are your limits lost?". Eur J Pediatr 178:1447

    Article  Google Scholar 

  17. Supino MC, Buonsenso D, Scateni S et al (2019) Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: a prospective study. Eur J Pediatr 178:623–632

    Article  Google Scholar 

  18. Buonsenso D, Musolino A (2018) Point of care diaphragm ultrasound in infants with bronchiolitis. Pediatr Pulmonol 53:1597

    Article  Google Scholar 

  19. Buonsenso D, Supino MC, Giglioni E et al (2018) Point of care diaphragm ultrasound in infants with bronchiolitis: a prospective study. Pediatr Pulmonol 53:778–786

    Article  Google Scholar 

  20. Berce V, Tomazin M, Gorenjak M et al (2019) The usefulness of lung ultrasound for the aetiological diagnosis of community-acquired pneumonia in children. Sci Rep 9:17957

    Article  Google Scholar 

  21. Lissaman C, Kanjanauptom P, Ong C et al (2019) Prospective observational study of point-of-care ultrasound for diagnosing pneumonia. Arch Dis Child 104:12–18

    Article  Google Scholar 

  22. Maffey A, Colom A, Venialgo C et al (2019) Clinical, functional, and radiological outcome in children with pleural empyema. Pediatr Pulmonol 54:525–530

    Article  Google Scholar 

  23. Pacilli M, Nataraja RM (2019) Management of paediatric empyema by video-assisted thoracoscopic surgery (VATS) versus chest drain with fibrinolysis: systematic review and meta-analysis. Paediatr Respir Rev 30:42–48

    PubMed  Google Scholar 

  24. Marhuenda C, Barceló C, Fuentes I et al (2014) Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial. Pediatrics 134:e1301–e1307

    Article  Google Scholar 

  25. Cobanoglu U, Sayir F, Bilici S, Melek M (2011) Comparison of the methods of fibrinolysis by tube thoracostomy and thoracoscopic decortication in children with stage II and III empyema: a prospective randomized study. Pediatr Rep 3:e29

    Article  Google Scholar 

  26. Kurt BA, Winterhalter KM, Connors RH et al (2006) Therapy of parapneumonic effusions in children: video-assisted thoracoscopic surgery versus conventional thoracostomy drainage. Pediatrics 118:e547–e553

    Article  Google Scholar 

  27. Sonnappa S, Cohen G, Owens CM et al (2006) Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med 174:221–227

    Article  Google Scholar 

  28. Chiu CY, Wong KS, Huang YC et al (2006) Echo-guided management of complicated parapneumonic effusion in children. Pediatr Pulmonol 41:1226–1232

    Article  Google Scholar 

  29. James CA, Braswell LE, Pezeshkmehr AH et al (2017) Stratifying fibrinolytic dosing in pediatric parapneumonic effusion based on ultrasound grade correlation. Pediatr Radiol 47:89–95

    Article  Google Scholar 

  30. Kushner LE, Nieves DJ, Osborne S et al (2019) Oral antibiotics for treating children with community-acquired pneumonia complicated by empyema. Clin Pediatr (Phila) 58:1401–1408

    Article  Google Scholar 

  31. De Benedictis FM, Carloni I (2019) Management of necrotizing pneumonia in children: time for a patient-oriented approach. Pediatr Pulmonol 54:1351–1353

    Article  Google Scholar 

Download references

Acknowledgements

We are grateful to Dr. Caterina Bock from Bambino Gesù Children Hospital for her support in reviewing images. We are thankful to the members of the Italian Academy of Thoracic Ultrasound (Accademia Di Ecografia Toracica, ADET) for training and inspiring Italian and international researchers in the field of lung ultrasound.

Author information

Affiliations

  1. Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Danilo Buonsenso, Antonietta Curatola, Rosa Morello & Piero Valentini

  2. Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy

    Danilo Buonsenso

  3. Department of Radiology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Paolo Tomà

  4. Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy

    Simona Scateni, Valentina Ferro, Maria Luisa D’Andrea, Nicola Pirozzi & Anna Maria Musolino

  5. Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy

    Piero Valentini

Authors
  1. Danilo Buonsenso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paolo Tomà
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simona Scateni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonietta Curatola
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rosa Morello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Piero Valentini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Valentina Ferro
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Luisa D’Andrea
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nicola Pirozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Anna Maria Musolino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Danilo Buonsenso.

Ethics declarations

Conflicts of interest

None

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Buonsenso, D., Tomà, P., Scateni, S. et al. Lung ultrasound findings in pediatric community-acquired pneumonia requiring surgical procedures: a two-center prospective study. Pediatr Radiol 50, 1560–1569 (2020). https://doi.org/10.1007/s00247-020-04750-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-020-04750-w

Keywords

  • Adolescents
  • Case-control study
  • Children
  • Community-acquired pneumonia
  • Complicated pneumonia
  • Lung
  • Pneumonia
  • Ultrasound