Pleural effusions in non-transplanted cystic fibrosis patients

Use of Lung Ultrasound in Cystic Fibrosis: Is It a Valuable Tool?

Cystic fibrosis (CF) is a multisystem disorder characterized by progressive respiratory deterioration, significantly impacting both quality of life and survival. Over the years, lung ultrasound (LUS) has emerged as a promising tool in pediatric respiratory due to its safety profile and ease at the bedside. In the era of highly effective CF modulator therapies and improved life expectancy, the use of non-ionizing radiation techniques could become an integral part of CF management, particularly in the pediatric population. The present review explores the potential role of LUS in CF management based on available data, analyzing all publications from January 2015 to January 2024, focusing on two key areas: LUS in CF pulmonary exacerbation and its utility in routine clinical management. Nonetheless, LUS exhibits a robust correlation with computed tomography (CT) scans and serves as an additional, user-friendly imaging modality in CF management, demonstrating high specificity and sensitivity in identification, especially in consolidations and atelectasis in the CF population. Due to its ability, LUS could be an instrument to monitor exacerbations with consolidations and to establish therapy duration and monitor atelectasis over time or their evolution after therapeutic bronchoalveolar lavage. On the basis of our analysis, sufficient data emerged showing a good correlation between LUS score and respiratory function tests. Good sensitivity and specificity of the methodology have been found in rare CF pulmonary complications such as effusion and pneumothorax. Regarding its use in follow-up management, the literature reports a moderate correlation between LUS scores and the type, extent, and CT severity score of bronchiectasis. A future validation of ultrasound scores specifically in CF patients could improve the use of LUS to identify pulmonary exacerbations and monitor disease progression. However, further research is needed to comprehensively establish the role of LUS in the CF population, particularly in elucidating its broader utility and long-term impact on patient care.

Persistent pleuritic chest pain in a patient with cystic fibrosis

A 14-year-old girl with cystic fibrosis (CF), homozygous for the Phe508del mutation, was electively admitted for optimisation of lung disease. Her CF was complicated by bronchiectasis, gastrostomy feeding, liver disease, and diabetes. Sputum cultures had identified Haemophilus parainfluenzae and Candida albicans in the previous 12 months, but she had never cultured Pseudomonas aeruginosa. She also had comorbid osteogenesis imperfecta (OI), type 3 phenotype, which was complicated by multiple long bone fractures including four rib fractures at birth. Her baseline forced expiratory volume in 1 s (FEV₁) was 44% (0.78 L), forced vital capacity (FVC) 54% (1.06 L), and FEV₁/FVC ratio 81% predicted. The combination of CF and OI had resulted in severe restrictive lung disease with nocturnal hypoventilation managed with bilevel noninvasive ventilation.

Pleural effusion is rare in cystic fibrosis. Infection leading to pleural effusion is likely to be polymicrobial, including contributory fungal infection; microbiology of pleural fluid is commonly discordant with sputum.https://bit.ly/3MJXrhk