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Flausino F, Manara LM, Sandre BB, Sawaya GN, Maurici R. Management of pediatric pleural empyema: a national survey of pediatric surgeons in Brazil. J Bras Pneumol 2024; 50:e20230318. [PMID: 38808824 PMCID: PMC11185142 DOI: 10.36416/1806-3756/e20230318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/17/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To identify how pediatric surgeons manage children with pneumonia and parapneumonic pleural effusion in Brazil. METHODS An online cross-sectional survey with 27 questions was applied to pediatric surgeons in Brazil through the Brazilian Association of Pediatric Surgery. The questionnaire had questions about type of treatment, exams, hospital structure, and epidemiological data. RESULTS A total of 131 respondents completed the questionnaire. The mean age of respondents was 44 ± 11 years, and more than half (51%) had been practicing pediatric surgery for more than 10 years. The majority of respondents (33.6%) reported performing chest drainage and fibrinolysis when facing a case of fibrinopurulent parapneumonic pleural effusion. A preference for video-assisted thoracic surgery instead of chest drainage plus fibrinolysis was noted only in the Northeast region. CONCLUSIONS Chest drainage plus fibrinolysis was the treatment adopted by most of the respondents in this Brazilian sample. There was a preference for large drains; in contrast, smaller drains were preferred by those who perform chest drainage plus fibrinolysis. Respondents would rather change treatment when facing treatment failure or in critically ill children.
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Affiliation(s)
- Felippe Flausino
- . Departamento de Cirurgia Pediátrica, Hospital Infantil Joana de Gusmão, Florianópolis (SC) Brasil
| | - Luiza Maes Manara
- . Departamento de Radiologia Pediátrica, Hospital Infantil Joana de Gusmão, Florianópolis (SC) Brasil
| | - Bruna Baioni Sandre
- . Departamento de Cirurgia Pediátrica, Hospital Infantil Joana de Gusmão, Florianópolis (SC) Brasil
| | - Gilson Nagel Sawaya
- . Departamento de Cirurgia Pediátrica, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, Campinas (SP) Brasil
| | - Rosemeri Maurici
- . Departamento de Clínica Médica, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
- . Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
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Nguyen-Thi TN, Nguyen-Dang K, Bui-Thi HD, Pham-Thi MH. A complex case of necrotizing pneumonia and parapneumonic effusion in a healthy 20-month-old child: Successful management with video-assisted thoracoscopic surgery and chest tube placement. Radiol Case Rep 2024; 19:1917-1925. [PMID: 38434785 PMCID: PMC10907134 DOI: 10.1016/j.radcr.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/04/2024] [Indexed: 03/05/2024] Open
Abstract
Necrotizing pneumonia (NP) is characterized by destruction of pulmonary tissue, resulting in multiple thin-walled cavities. There are limited reports on NP and parapneumonic effusion cases in children associated with Pseudomonas aeruginosa. Currently, there is no consensus regarding the optimal timing for video-assisted thoracoscopic surgery (VATS) following failure of chest tube placement and antibiotic treatment. A healthy 20-month-old child was hospitalized with symptoms of community-acquired pneumonia, progressing to severe NP and parapneumonic effusion. Despite receiving broad-spectrum antibiotics and chest tube placement on the third day of treatment, the condition continued to deteriorate, prompting VATS intervention on the sixth day. The presence of a "split pleural sign" and extensive lung necrosis on chest computed tomography contributed to initial treatment failure. Multidrug resistance P. aeruginosa was identified through nasal trachea aspiration specimens on the eighth day of treatment, leading to an adjustment in antibiotic therapy to high-dose meropenem and amikacin. Subsequently, the patient became afebrile, showed clinical improvement, and was discharged after 35 days of treatment. Through this case, we aim to emphasize an unusual pathogenic bacteria in the context of NP and the need for standardized surgical interventions in pediatric patients with NP.
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Affiliation(s)
- Thuy-Ngan Nguyen-Thi
- Department of Paediatrics, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Khoa Nguyen-Dang
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hanh-Duyen Bui-Thi
- Department of Intensive Care, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Minh-Hong Pham-Thi
- Department of Paediatrics, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Respiratory Department, Children's Hospital No2, Ho Chi Minh City, Vietnam
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3
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Simma L, Pocepcova V, Fontana S. A Boy With Ten Days of Fever. Ann Emerg Med 2023; 82:271-361. [PMID: 37596015 DOI: 10.1016/j.annemergmed.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Leopold Simma
- Emergency Department, University's Children Hospital Zurich, and University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Vanda Pocepcova
- Department of Diagnostic Imaging, University's Children Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Sonja Fontana
- Emergency Department, University's Children Hospital Zurich, and University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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Luo Y, Wang Y. Clinical Characteristics of Necrotizing Pneumonia Caused by Different Pathogens. Infect Drug Resist 2023; 16:3777-3786. [PMID: 37337573 PMCID: PMC10276989 DOI: 10.2147/idr.s419294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023] Open
Abstract
Objective To explore the clinical characteristics of necrotizing pneumonia (NP) caused by different pathogens. Methods A total of 282 children with NP admitted to Kunming Children's Hospital from January 2014 to November 2022 were enrolled. The clinical data of all children was collected. According to the different pathogens causing NP, the children were divided into three groups: the Mycoplasma pneumoniae necrotizing pneumonia (MPNP) group, the bacterial necrotizing pneumonia (BNP) group, and necrotizing pneumonia with no pathogen detected (NNP) group. The basic information, symptoms, signs, laboratory tests, radiological features, treatment, and prognosis of the three groups were compared. Results Among the 282 cases of NP, there were 62 (22.0%) cases of MPNP, 98 (34.75%) cases of BNP, and 142 (50.35%) cases of NNP. The most common bacteria causing NP were Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Acinetobacter baumannii, respectively. Most clinical features of the three groups were statistically significant. The area under the concentration curve of white blood cell, C-reactive protein, albumin, neutrophil percentage, and fibrinogen in differentiating MPNP from BNP were 0.743 (0.638-0.849), 0.797 (0.711-0.883), 0.766 (0.671-0.861), 0.616 (0.509-0.724), and 0.634 (0.523-0.744), respectively. The decision curve showed that white blood cells, albumin, and C-reactive protein had good clinical application in differentiating MPNP from BNP. All patients were improved and discharged without death. Conclusion Bacteria are the most common cause of NP, and the most common bacteria are Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae. NP with no pathogen detected accounted for a large proportion. white blood, C-reactive protein, and albumin can identify the pathogens of NP. Patients with BNP were more severe, had a longer hospital stay, and were more likely to undergo closed drainage and surgery.
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Affiliation(s)
- Yonghan Luo
- Second Department of Infectious Disease, Kunming Children's Hospital, Kunming, Yunnan, People's Republic of China
| | - Yanchun Wang
- Second Department of Infectious Disease, Kunming Children's Hospital, Kunming, Yunnan, People's Republic of China
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5
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Chen Y, Li L, Wang C, Zhang Y, Zhou Y. Necrotizing Pneumonia in Children: Early Recognition and Management. J Clin Med 2023; 12:jcm12062256. [PMID: 36983257 PMCID: PMC10051935 DOI: 10.3390/jcm12062256] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023] Open
Abstract
Necrotizing pneumonia (NP) is an uncommon complicated pneumonia with an increasing incidence. Early recognition and timely management can bring excellent outcomes. The diagnosis of NP depends on chest computed tomography, which has radiation damage and may miss the optimal treatment time. The present review aimed to elaborate on the reported predictors for NP. The possible pathogenesis of Streptococcus pneumoniae, Staphylococcus aureus, Mycoplasma pneumoniae and coinfection, clinical manifestations and management were also discussed. Although there is still a long way for these predictors to be used in clinical, it is necessary to investigate early predictors for NP in children.
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Affiliation(s)
- Yuanyuan Chen
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Lanxin Li
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Chenlu Wang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Yuanyuan Zhang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
- Correspondence: (Y.Z.); (Y.Z.)
| | - Yunlian Zhou
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- National Clinical Research Center for Child Health, Hangzhou 310052, China
- Correspondence: (Y.Z.); (Y.Z.)
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6
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Luo Y, Wang Y. Development of a Nomogram for Predicting Massive Necrotizing Pneumonia in Children. Infect Drug Resist 2023; 16:1829-1838. [PMID: 37016631 PMCID: PMC10066889 DOI: 10.2147/idr.s408198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
Objective This study aimed to develop a nomogram model for predicting massive necrotizing pneumonia (NP) in children. Methods A total of 282 children with NP admitted to Kunming Children's Hospital from January 2014 to November 2022 were enrolled. The children with NP were divided into massive necrotizing pneumonia (MNP) group and non-MNP group according to the severity of the lung necrosis. The clinical data of the children were collected, and least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression models were used to analyze the influencing factors of MNP. A nomogram model was constructed, and its predictive efficacy was evaluated. Results The predictors selected by LASSO regression analysis were: haematogenous spread, white blood cell (WBC), hemoglobin (Hb), C-reactive protein (CRP), lactate dehydrogenase (LDH), and activated partial thromboplastin time (APTT) (P < 0.05). Based on the above independent influencing factors, a nomogram model for MNP was constructed. The bootstrap method was used to repeat sampling 1000 times. The results showed that the consistency index of the nomogram model in predicting MNP was 0.833 in the training set and 0.810 in the validation set. The results of ROC curve analysis showed that the area under the receiver-operating-characteristic curve (AUC) of the nomogram model for predicting MNP was 0.889 [95% CI (0.818, 0.959)] in the training set and 0.814 [95% CI (0.754, 0.874)] in the validation set. The calibration curve of the nomogram predicting MNP was basically close to the actual curve. The decision curve showed that the nomogram had good clinical utility. Conclusion We developed a nomogram for predicting MNP, which can help clinicians identify the severity of lung necrosis early.
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Affiliation(s)
- Yonghan Luo
- Second Department of Infectious Disease, Kunming Children’s Hospital, Kunming, Yunnan, People’s Republic of China
| | - Yanchun Wang
- Second Department of Infectious Disease, Kunming Children’s Hospital, Kunming, Yunnan, People’s Republic of China
- Correspondence: Yanchun Wang, Second Department of Infectious Disease, Kunming Children’s Hospital, Kunming, Yunnan, 650000, People’s Republic of China, Email
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Kazi S, Hernstadt H, Abo YN, Graham H, Palmer M, Graham SM. The utility of chest x-ray and lung ultrasound in the management of infants and children presenting with severe pneumonia in low-and middle-income countries: A pragmatic scoping review. J Glob Health 2022; 12:10013. [PMID: 36560909 PMCID: PMC9789364 DOI: 10.7189/jogh.12.10013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Chest x-ray (CXR) is commonly used (when available) to support clinical management decisions for child pneumonia and provide a reference standard for diagnosis in research studies. However, its diagnostic and technical limitations for both purposes are well recognised. Recent evidence suggests that lung ultrasound (LUS) may have diagnostic utility in pneumonia. This systematic scoping review of research on the utility of CXR and LUS in the management of severe childhood pneumonia aims to inform pragmatic guidelines for low- and middle-income countries (LMICs) and identify gaps in knowledge. Methods We included peer-reviewed studies published between 2000 and 2020 in infants and children aged from one month to nine years, presenting with severe pneumonia. CXR studies were limited to those from LMICs, while LUS studies included any geographic region. LUS and CXR articles were mapped into the following themes: indications, role in diagnosis, role in management, impact on outcomes, and practical considerations for LMIC settings. Results 85 articles met all eligibility criteria, including 27 CXR studies and 58 LUS studies. CXR studies were primarily observational and examined associations between radiographic abnormalities and pneumonia aetiology or outcomes. The most consistent finding was an association between CXR consolidation and risk of mortality. Difficulty obtaining quality CXR images and inter-reader variability in interpretation were commonly reported challenges. Research evaluating indications for CXR, role in management, and impact on patient outcomes was very limited. LUS studies primarily focused on diagnostic accuracy. LUS had higher sensitivity for identification of consolidation than CXR. There are gaps in knowledge regarding diagnostic criteria, as well as the practical utility of LUS in the diagnosis and management of pneumonia. Most LUS studies were conducted in HIC settings with experienced operators; however, small feasibility studies indicate that good inter-operator reliability may be achieved by training of novice clinicians in LMIC settings. Conclusions The available evidence does not support the routine use of CXR or LUS as essential tools in the diagnosis and initial management of severe pneumonia. Further evaluation is required to determine the clinical utility and feasibility of both imaging modalities in low-resource settings.
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Affiliation(s)
- Saniya Kazi
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,Monash Health, Melbourne, Victoria, Australia
| | | | - Yara-Natalie Abo
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Hamish Graham
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Megan Palmer
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen M Graham
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,Monash Health, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
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8
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Baldes N, Bölükbas S. Entzündliche und infektiöse Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen. Zentralbl Chir 2022; 147:287-298. [DOI: 10.1055/a-1720-2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungEntzündliche Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen umfassen ein weites Spektrum von der komplizierten Pneumonie, der Tuberkulose, Mykosen bis hin zur Echinokokkose.
Die Häufigkeit hängt stark von der geografischen Herkunft ab. Diese Übersichtsarbeit gibt einen Überblick von der Diagnostik bis hin zur chirurgischen Therapie dieser Erkrankungen beim
pädiatrischen Kollektiv.
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Affiliation(s)
- Natalie Baldes
- Klinik für Thoraxchirurgie, KEM Kliniken Essen-Mitte, Essen, Deutschland
| | - Servet Bölükbas
- Klinik für Thoraxchirurgie, KEM Kliniken Essen-Mitte, Essen, Deutschland
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9
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Kucerova B, Kovacova AS, Polivka N, Cejnarová K, Doucha M, Coufal S, Hlava S, Wasserbauer M, Dotlacil V, Kyncl M, Snajdauf J, Koucky V, Pohunek P, Rygl M. CT findings predicting lung resection in children with complicated community-acquired pneumonia. Pediatr Surg Int 2022; 38:431-436. [PMID: 35092464 DOI: 10.1007/s00383-022-05071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate computed tomography (CT) features which predict lung resection in children with complicated community-acquired pneumonia. METHODS A retrospective study of CT findings of patients with complicated pneumonia treated between January 2010 and December 2019. Fisher's exact test and ROC curves were used for statistical analysis. RESULTS The study cohort consisted of 84 patients who underwent chest CT for complicated pneumonia. Lung resection was performed in 36 patients, 3 patients were treated by lung decortication, 45 patients were cured conservatively. Seven CT features were found statistically significant among the patients who underwent lung resection. 80.5% of patients from the resection group had two or more of these features on the initial CT scan, 64% had three or more. According to ROC analysis, simultaneous occurrence of multiple cavities equal to or greater than 3 cm and lung abscess predicted a pulmonary resection. CONCLUSION The combination of CT features which clearly predict lung resection are the simultaneous occurrence of multiple cavities ≥ 3 cm and lung abscess. The most common triple combination of CT signs in the resected group of patients were multiple cavities ≥ 3 cm, consolidation of lung tissue and pleural effusion < 3 cm.
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Affiliation(s)
- Barbora Kucerova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic.
| | - A S Kovacova
- Department of Radiology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - N Polivka
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - K Cejnarová
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - M Doucha
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - S Coufal
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - S Hlava
- Department of Internal Medicine, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - M Wasserbauer
- Department of Internal Medicine, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - V Dotlacil
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - M Kyncl
- Department of Radiology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - J Snajdauf
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - V Koucky
- Department of Pediatrics, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - P Pohunek
- Department of Pediatrics, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - M Rygl
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
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10
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Carrard J, Bacher S, Rochat-Guignard I, Knebel JF, Alamo L, Meuwly JY, Tenisch E. Necrotizing pneumonia in children: Chest computed tomography vs. lung ultrasound. Front Pediatr 2022; 10:898402. [PMID: 36090566 PMCID: PMC9461715 DOI: 10.3389/fped.2022.898402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The utilization of contrast-enhanced computed tomography (CT) of the chest for the diagnosis of necrotizing pneumonia (NP), a complication of community-acquired pneumonia, is controversial because of the inherent ionizing radiation involved. Over the past few years, the growing availability of bedside Lung Ultrasound (LUS) devices has led to increased use of this nonionizing imaging method for diagnosing thoracic pathology, including pneumonia. OBJECTIVE The objectives of this study were as follows: first, to compare the performance of LUS vs. CT in the identification of certain radiological signs of NP, and second, to determine whether LUS could replace CT in the diagnosis of NP. MATERIALS AND METHODS We compared retrospectively the CT and LUS images of 41 patients between 2005 and 2018 in whom at least one contrast-injected chest CT scan and one LUS had been undertaken fewer than 7 days apart. RESULTS Pleural effusions were demonstrated almost systematically (100% on CT vs. 95.8% on LUS). Visualization of septations in pleural effusions was clearly superior on LUS (20.4% on CT vs 62.5% on LUS). Concerning the detection of necrosis, we observed a strong correlation between LUS and the gold-standard CT (95.8% on LUS vs. 93.7% on CT). Parenchymal cavities were more easily detected on CT than on LUS (79.1 vs. 35.4%). CONCLUSION LUS has shown to be as effective as CT in the diagnosis of NP. The use of CT in patients with NP could be limited to the detection of complications such as bronchopleural fistulae in unfavorably evolving diseases.
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Affiliation(s)
- Johann Carrard
- Department of Radiology, Riviera-Chablais Hospital, Rennaz, and University of Lausanne, Lausanne, Switzerland
| | - Sebastien Bacher
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Isabelle Rochat-Guignard
- Department of Radiology, Riviera-Chablais Hospital, Rennaz, and University of Lausanne, Lausanne, Switzerland.,Department Woman-Mother-Child, Unit of Pediatric Pulmonology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-François Knebel
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Leonor Alamo
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Yves Meuwly
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Estelle Tenisch
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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11
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Musa MJ, Yousef M, Adam M, Wagealla A, Boshara L, Belal D, Abukonna A. The Role of Lung Ultrasound Before and During the COVID-19 Pandemic: A review article. Curr Med Imaging 2021; 18:593-603. [PMID: 34620067 DOI: 10.2174/1573405617666211006122842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/31/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022]
Abstract
Lung ultrasound [LUS] has evolved considerably over the last years. The aim of the current review is to conduct a systematic review reported from a number of studies to show the usefulness of [LUS] and point of care ultrasound for diagnosing COVID-19. A systematic search of electronic data was conducted including the national library of medicine, and the national institute of medicine, PubMed Central [PMC] to identify the articles depended on [LUS] to monitor COVID-19. This review highlights the ultrasound findings reported in articles before the pandemic [11], clinical articles before COVID-19 [14], review studies during the pandemic [27], clinical cases during the pandemic [5] and other varying aims articles. The reviewed studies revealed that ultrasound findings can be used to help in the detection and staging of the disease. The common patterns observed included irregular and thickened A-lines, multiple B-lines ranging from focal to diffuse interstitial consolidation, and pleural effusion. Sub-plural consolidation is found to be associated with the progression of the disease and its complications. Pneumothorax was not recorded for COVID-19 patients. Further improvement in the diagnostic performance of [LUS] for COVID-19 patients can be achieved by using elastography, contrast-enhanced ultrasound, and power Doppler imaging.
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Affiliation(s)
- Mustafa J Musa
- University of Jeddah, College of Applied Medical Sciences, Department of Applied Radiologic Technology, Jeddah . Saudi Arabia
| | - Mohamed Yousef
- Radiologic Sciences Program, Batterjee Medical College, Jeddah . Saudi Arabia
| | - Mohammed Adam
- King Khalid University, College of Medical Applied Sciences, Department of Diagnostic Radiology Sciences, Abha . Saudi Arabia
| | - Awadalla Wagealla
- Radiological Sciences Department, Al-Ghad International College for Applied Medical Science, Abha. Saudi Arabia
| | - Lubna Boshara
- University of Jeddah, College of Applied Medical Sciences, Department of Applied Radiologic Technology, Jeddah . Saudi Arabia
| | - Dalia Belal
- University of Jeddah, College of Applied Medical Sciences, Department of Applied Radiologic Technology, Jeddah. Saudi Arabia
| | - Ahmed Abukonna
- Radiological Sciences Department, Al-Ghad International College for Applied Medical Science, Abha. Sudan
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12
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Ammirabile A, Buonsenso D, Di Mauro A. Lung Ultrasound in Pediatrics and Neonatology: An Update. Healthcare (Basel) 2021; 9:1015. [PMID: 34442152 PMCID: PMC8391473 DOI: 10.3390/healthcare9081015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 12/24/2022] Open
Abstract
The potential role of ultrasound for the diagnosis of pulmonary diseases is a recent field of research, because, traditionally, lungs have been considered unsuitable for ultrasonography for the high presence of air and thoracic cage that prevent a clear evaluation of the organ. The peculiar anatomy of the pediatric chest favors the use of lung ultrasound (LUS) for the diagnosis of respiratory conditions through the interpretation of artefacts generated at the pleural surface, correlating them to disease-specific patterns. Recent studies demonstrate that LUS can be a valid alternative to chest X-rays for the diagnosis of pulmonary diseases, especially in children to avoid excessive exposure to ionizing radiations. This review focuses on the description of normal and abnormal findings during LUS of the most common pediatric pathologies. Current literature demonstrates usefulness of LUS that may become a fundamental tool for the whole spectrum of lung pathologies to guide both diagnostic and therapeutic decisions.
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Affiliation(s)
- Angela Ammirabile
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, “Aldo Moro” University of Bari, 70100 Bari, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonio Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Via Conversa 12, 10135 Margherita di Savoia, Italy;
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13
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Komorowska-Piotrowska A, Jaworska J, Pomiećko A, Wiśniewski J, Woźniak M, Littwin B, Kryger M, Kwaśniewicz P, Szczyrski J, Kulińska-Szukalska K, Buda N, Doniec Z, Kosiak W. Response to Comment on Jaworska, J. et al. Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children. Diagnostics 2020, 10, 935. Diagnostics (Basel) 2021; 11:66. [PMID: 33406637 PMCID: PMC7823452 DOI: 10.3390/diagnostics11010066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 12/29/2022] Open
Abstract
Thank you for the opportunity to respond to the issues raised by Nenna et al [...].
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Affiliation(s)
| | - Joanna Jaworska
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Andrzej Pomiećko
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdańsk, Poland; (A.P.); (J.W.); (B.L.); (M.K.); (J.S.)
| | - Jakub Wiśniewski
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdańsk, Poland; (A.P.); (J.W.); (B.L.); (M.K.); (J.S.)
| | - Mariusz Woźniak
- Department of Pulmonology, Institute of Tuberculosis and Lung Diseases, Regional Branch in Rabka Zdrój, 34-700 Rabka-Zdrój, Poland; (M.W.); (Z.D.)
| | - Błażej Littwin
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdańsk, Poland; (A.P.); (J.W.); (B.L.); (M.K.); (J.S.)
| | - Magdalena Kryger
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdańsk, Poland; (A.P.); (J.W.); (B.L.); (M.K.); (J.S.)
| | - Piotr Kwaśniewicz
- Department of Diagnostic Imaging, Mother and Child Institute, 01-211 Warsaw, Poland;
| | - Józef Szczyrski
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdańsk, Poland; (A.P.); (J.W.); (B.L.); (M.K.); (J.S.)
| | - Katarzyna Kulińska-Szukalska
- Pediatric Department of Respiratory Tract Disorders, Lung Diseases and Rehabilitation Center, 91-520 Łódź, Poland;
| | - Natalia Buda
- Department and Clinic of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, 80-210 Gdansk, Poland
| | - Zbigniew Doniec
- Department of Pulmonology, Institute of Tuberculosis and Lung Diseases, Regional Branch in Rabka Zdrój, 34-700 Rabka-Zdrój, Poland; (M.W.); (Z.D.)
| | - Wojciech Kosiak
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland;
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14
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A Successful Medical Treatment of Necrotizing Pneumonia in a Pediatric Patient. Case Rep Pediatr 2021; 2020:8875119. [PMID: 33381341 PMCID: PMC7765722 DOI: 10.1155/2020/8875119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022] Open
Abstract
Necrotizing pneumonia is a rare, serious complication of pneumonia in children. We present a case of a 20-month-old girl presenting with respiratory distress which later be diagnosed with necrotizing pneumonia. In this paper, we highlight the role of imaging such as chest X-ray, chest CT, and lung ultrasonography for diagnosis and the importance of intravenous antibiotic therapy for better outcome.
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15
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Jaworska J, Komorowska-Piotrowska A, Pomiećko A, Wiśniewski J, Woźniak M, Littwin B, Kryger M, Kwaśniewicz P, Szczyrski J, Kulińska-Szukalska K, Buda N, Doniec Z, Kosiak W. Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children. Diagnostics (Basel) 2020; 10:diagnostics10110935. [PMID: 33187099 PMCID: PMC7697535 DOI: 10.3390/diagnostics10110935] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 12/21/2022] Open
Abstract
This evidence-based consensus aims to establish the role of point-of-care lung ultrasound in the management of pneumonia and bronchiolitis in paediatric patients. A panel of thirteen experts form five Polish tertiary pediatric centres was involved in the development of this document. The literature search was done in PubMed database. Statements were established based on a review of full-text articles published in English up to December 2019. The development of this consensus was conducted according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluations)-adopted and Delphi method. Initially, 22 proposed statements were debated over 3 rounds of on-line discussion and anonymous voting sessions. A total of 17 statements were agreed upon, including four statements referring to general issues, nine referring to pneumonia and four to bronchiolitis. For five statements experts did not achieve an agreement. The evidence supporting each statement was evaluated to assess the strength of each statement. Overall, eight statements were rated strong, five statements moderate, and four statements weak. For each statement, experts provided their comments based on the literature review and their own experience. This consensus is the first to establish the role of lung ultrasound in the diagnosis and management of pneumonia and bronchiolitis in children as an evidence-based method of imaging.
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Affiliation(s)
- Joanna Jaworska
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | | | - Andrzej Pomiećko
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdansk, Poland; (A.P.); (J.W.); (B.L.); (J.S.); (M.K.)
| | - Jakub Wiśniewski
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdansk, Poland; (A.P.); (J.W.); (B.L.); (J.S.); (M.K.)
| | - Mariusz Woźniak
- Department of Pulmonology, Institute of Tuberculosis and Lung Diseases, Regional Branch in Rabka Zdrój, 34-700 Rabka-Zdroj, Poland; (M.W.); (Z.D.)
| | - Błażej Littwin
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdansk, Poland; (A.P.); (J.W.); (B.L.); (J.S.); (M.K.)
| | - Magdalena Kryger
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdansk, Poland; (A.P.); (J.W.); (B.L.); (J.S.); (M.K.)
| | - Piotr Kwaśniewicz
- Department of Diagnostic Imaging, Mother and Child Institute, 01-211 Warsaw, Poland;
| | - Józef Szczyrski
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdansk, Poland; (A.P.); (J.W.); (B.L.); (J.S.); (M.K.)
| | - Katarzyna Kulińska-Szukalska
- Pediatric Department of Respiratory Tract Disorders, Lung Diseases and Rehabilitation Center, 91-520 Łódź, Poland;
| | - Natalia Buda
- Department and Clinic of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, 80-210 Gdansk, Poland
- Correspondence:
| | - Zbigniew Doniec
- Department of Pulmonology, Institute of Tuberculosis and Lung Diseases, Regional Branch in Rabka Zdrój, 34-700 Rabka-Zdroj, Poland; (M.W.); (Z.D.)
| | - Wojciech Kosiak
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland;
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16
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Andrés-Martín A, Escribano Montaner A, Figuerola Mulet J, García García ML, Korta Murua J, Moreno-Pérez D, Rodrigo-Gonzalo de Liria C, Moreno Galdó A. Consensus Document on Community-Acquired Pneumonia in Children. SENP-SEPAR-SEIP. Arch Bronconeumol 2020; 56:725-741. [PMID: 32534869 DOI: 10.1016/j.arbres.2020.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/28/2020] [Accepted: 03/30/2020] [Indexed: 12/23/2022]
Abstract
Community-acquired pneumonia (CAP) is a prevalent disease among children and is frequently associated with both diagnostic and therapeutic uncertainties. Consensus has been reached between SEPAR, SENP and SEIP, and their conclusions are as follows.
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Affiliation(s)
- Anselmo Andrés-Martín
- Sección de Neumología Pediátrica, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, España.
| | - Amparo Escribano Montaner
- Unidad de Neumología Pediátrica, Servicio de Pediatría, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España
| | - Joan Figuerola Mulet
- Sección de Neumología y Alergia Pediátricas, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, España
| | - Maria Luz García García
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Universidad Alfonso X El Sabio, Villanueva de la Cañada, Madrid, España
| | - Javier Korta Murua
- Sección de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Donostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Guipúzcoa, España
| | - David Moreno-Pérez
- Infectología e Inmunodeficiencias, UGC de Pediatría, Hospital Materno Infantil, Hospital Regional Universitario de Málaga, Grupo de Investigación IBIMA, Universidad de Málaga, Málaga, España
| | - Carlos Rodrigo-Gonzalo de Liria
- Servicio de Pediatría, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, España
| | - Antonio Moreno Galdó
- Sección de Neumología y Alergia Pediátricas, Servicio de Pediatría, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España; CIBER de enfermedades raras, Madrid, España
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17
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de Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. Complicated pneumonia in children. Lancet 2020; 396:786-798. [PMID: 32919518 DOI: 10.1016/s0140-6736(20)31550-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Patients have initial imaging with chest radiography and ultrasound, which can also be used to assess the lung parenchyma, to identify pleural fluid; CT scanning is not usually indicated. Complicated pneumonia is treated with a prolonged course of intravenous antibiotics, and then oral antibiotics. The initial choice of antibiotic is guided by local microbiological knowledge and by subsequent positive cultures and molecular testing, including on pleural fluid if a drainage procedure is done. Information from pleural space imaging and drainage should guide the decision on whether to administer intrapleural fibrinolytics. Most patients are treated by drainage and more extensive surgery is rarely needed; in any event, in low-income and middle-income countries, resources for extensive surgeries are scarce. The clinical course of complicated community-acquired pneumonia can be prolonged, especially when patients have necrotising pneumonia, but complete recovery is the usual outcome.
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Affiliation(s)
| | - Eitan Kerem
- Department of Pediatrics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial School of Medicine, Imperial College London, London, UK.
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18
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Copetti R, Cominotto F, Meduri S, Orso D. The "Survived Lung:" An Ultrasound Sign of "Bubbly Consolidation" Pulmonary Infarction. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2546-2550. [PMID: 32507699 DOI: 10.1016/j.ultrasmedbio.2020.04.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
Since the presence of "bubbly consolidation" (central lucencies) on a multi-slice computed tomography pulmonary angiography (MCTPA) is one of the highly specific imaging appearances of infarct secondary to pulmonary embolism, we investigated the ultrasound characteristics of these infarctions. In this study, 118 patients with MCTPA diagnosis of acute pulmonary embolism were enrolled. Pulmonary infarctions were detected in 21 patients (17.7%), of which 10 (47.6%) showed the typical appearance of bubbly consolidation on MCTPA. Lung ultrasound (LUS) was performed to evaluate the characteristics of the infarcts highlighted by MCTPA. The bubbly consolidations showed a very peculiar echographic aspect represented by a triangular hypoechoic consolidation with sharp margins, the absence of air bronchograms and a mostly central roundish hyperechoic area. Air lucencies within a pulmonary infarct is hypothesized to represent the coexistence of aerated non-infarcted lung with the infarcted lung in the same lobule. The ultrasound appearance confirms this hypothesis, so we named the roundish hyperechoic area the "survived lung." This picture was found in all patients with a diagnosis of bubbly consolidation on MCTPA (100%). Χ2 between MCTPA and LUS regarding the bubbly consolidation diagnosis is 17.18 (df = 1; p value = 0.00003). Bubbly consolidations show a very typical appearance on LUS. Their detection suggests further investigations (MCTPA or point-of-care multi-organ ultrasonography).
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Affiliation(s)
- Roberto Copetti
- Department of Emergency Medicine, University Hospital of Cattinara, Trieste, Italy
| | - Franco Cominotto
- Department of Emergency Medicine, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Stefano Meduri
- Radiology Department, Latisana/Palmanova Hospitals, Latisana (UD), Italy
| | - Daniele Orso
- Anesthesiology and Intensive Care Medicine Division, Department of Medicine, ASUIUD University Hospital of Udine, Udine, Italy.
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19
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Arruda AA, Fortuna JP, Raposo AT, Soares MRP, Gonçalves JA, Gomes MF. Influenza virus infection complicated by bacterial necrotising pneumonia: two case reports. Paediatr Int Child Health 2020; 40:202-206. [PMID: 32281523 DOI: 10.1080/20469047.2020.1748955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Necrotising pneumonia (NP) is a potentially severe complication of community-acquired pneumonia characterised by necrosis of consolidated lung tissue. A 7-year-old boy and a 6-year-old boy are presented, both of whom had a complicated influenza infection which evolved into severe NP caused by Streptococcus pneumoniae. Both needed intensive care for invasive respiratory support. Despite extensive pleural involvement in both cases, only one required thoracic surgery. Case 1 also developed anaemia, hyponatraemia and hypo-albuminaemia, resulting in generalised oedema. Despite the severe morbidity, both boys made a full recovery. The diagnosis of NP should always be considered in a child with pneumonia who remains unwell despite 72 hours of appropriate antibiotics, particularly if there is evidence of pleural disease. Although S. pneumoniae is the main agent for NP, the influenza virus may be a precipitating factor.
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Affiliation(s)
- Augusta Aragão Arruda
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
| | - Joana Pacheco Fortuna
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
| | - Ana Teresa Raposo
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
| | - Marina Rita Paulo Soares
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
| | - Juan António Gonçalves
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
| | - Maria Fernanda Gomes
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
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20
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Chan SS, Kotecha MK, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, Bardo DME, Brown BP, Chandra T, Dorfman SR, Garber MD, Moore MM, Nguyen JC, Shet NS, Siegel A, Valente JH, Karmazyn B. ACR Appropriateness Criteria® Pneumonia in the Immunocompetent Child. J Am Coll Radiol 2020; 17:S215-S225. [PMID: 32370966 DOI: 10.1016/j.jacr.2020.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 12/27/2022]
Abstract
Pneumonia is one of the most common acute infections and the single greatest infectious cause of death in children worldwide. In uncomplicated, community-acquired pneumonia in immunocompetent patients, the diagnosis is clinical and imaging has no role. The first role of imaging is to identify complications associated with pneumonia such as pleural effusion, pulmonary abscess, and bronchopleural fistula. Radiographs are recommended for screening for these complications and ultrasound and CT are recommended for confirmation. The second role of imaging is to identify underlying anatomic conditions that may predispose patients to recurrent pneumonia. CT with intravenously administered contrast is recommended for this evaluation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Manish K Kotecha
- Research Author, Children's Mercy Hospital, Kansas City, Missouri
| | - Cynthia K Rigsby
- Panel Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ramesh S Iyer
- Panel Vice-Chair, Seattle Children's Hospital, Seattle, Washington
| | | | | | | | - Brandon P Brown
- Riley Hospital for Children Indiana University, Indianapolis, Indiana
| | | | | | - Matthew D Garber
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American Academy of Pediatrics
| | - Michael M Moore
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Narendra S Shet
- Children's National Health System, Washington, District of Columbia
| | - Alan Siegel
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jonathan H Valente
- Alpert Medical School of Brown University, Providence, Rhode Island; American College of Emergency Physicians
| | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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21
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de Benedictis FM, Carloni I. Management of necrotizing pneumonia in children: Time for a patient-oriented approach. Pediatr Pulmonol 2019; 54:1351-1353. [PMID: 31254327 DOI: 10.1002/ppul.24412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | - Ines Carloni
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
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22
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Abstract
OBJECTIVES Lung ultrasound has shown increasing diagnostic value in many lung diseases and has become an efficient tool in the management of dyspnea. In the present case report, we describe a new ultrasound feature of potential interest. DATA SOURCES Clinical observation of a patient. STUDY SELECTION Case report. DATA EXTRACTION Data were extracted from medical records, after obtaining consent from the patient's family. Illustrations were extracted from the imaging software and a video device. DATA SYNTHESIS A 56-year-old man was admitted with pneumonia of adverse outcome. Lung ultrasound, a method increasingly considered as a bedside gold standard in critically ill patients due to its overwhelming advantages, was the only tool able to specify the lung injuries. We describe herein a distinctive sign unequivocally evoking a destructive process suggestive of pulmonary gangrene, a variant of the fractal sign combining a lung consolidation with an underlying heterogeneous free fluid. CONCLUSIONS Lung ultrasound may help highlight pulmonary gangrene, a poorly-known disease, with this new ultrasonographic description. The next step will be to ascertain the relation between this new ultrasound feature and pulmonary gangrene and to assess how this bedside diagnosis could impact the prognosis of the disease.
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23
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Pneumonectomy in a Child with Multilobar Pneumatocele Secondary to Necrotizing Pneumonia: Case Report and Review of the Literature. Case Rep Pediatr 2019; 2019:2464390. [PMID: 31396429 PMCID: PMC6664550 DOI: 10.1155/2019/2464390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/07/2019] [Indexed: 11/19/2022] Open
Abstract
Background Community-acquired pneumonia (CAP) is common within pediatrics and contributes disproportionately to morbidity and mortality. Necrotizing pneumonia is a well-documented complication of CAP. It is thought to be caused by necrosis and liquefaction of consolidated lung and can result in damage to lung parenchyma, including pneumatocele development. Management of necrotizing pneumonia with pneumatocele may include hospitalization, intensive care unit admission, and lengthy antibiotic courses. Severe cases may need invasive procedures. Case Presentation We present a case of severe necrotizing pneumonia requiring prolonged venovenous extracorporeal membrane oxygenation (V-V ECMO) with development of persistent pneumatoceles, requiring pneumonectomy while on ECMO support to allow for decannulation and extubation. Conclusions In critically ill patients with extensive unilateral necrotizing pneumonia with pneumatocele development, surgical intervention can be considered when attempts to wean ventilation have been unsuccessful. This case provides evidence that V-V ECMO and pneumonectomy is a viable salvage therapy in the most critically unwell children.
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24
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Chiu CY, Cheng ML, Wong KS, Lai SH, Chiang MH, Tsai MH, Lin G. Metabolomics Reveals Anaerobic Bacterial Fermentation and Hypoxanthine Accumulation for Fibrinous Pleural Effusions in Children with Pneumonia. J Proteome Res 2019; 18:1248-1254. [PMID: 30757903 DOI: 10.1021/acs.jproteome.8b00864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fibrin formation in infectious parapneumonic effusion (IPE) characterizes complicated parapneumonic effusion and is important for providing guidelines for the management of IPEs that require aggressive interventions. We aim to identify metabolic mechanisms associated with bacterial invasion, inflammatory cytokines, and biochemical markers in cases of fibrinous infectious pleural effusions in children with pneumonia. Pleural fluid metabolites were determined by 1H nuclear magnetic resonance spectroscopy. Metabolites that contributed to the separation between fibrinous and nonfibrinous IPEs were identified using supervised partial least squares discriminant analysis ( Q2/ R2 = 0.84; Ppermutation < 0.01). IL-1β in the inflammatory cytokines and glucose in the biochemical markers were significantly correlated with 11 and 9 pleural fluid metabolites, respectively, and exhibited significant overlaps. Four metabolites, including glucose, lactic acid, 3-hydroxybutyric acid, and hypoxanthine, were significantly correlated with plasminogen activator inhibitor type 1 in the fibrinolytic system enzymes. Metabolic pathway analysis revealed that anaerobic bacterial fermentation with increased lactic acid and butyric acid via glucose consumption and adenosine triphosphate hydrolysis with increased hypoxanthine appeared to be associated with fibrinous IPE. Our results demonstrate that an increase in lactic acid anaerobic fermentation and hypoxanthine accumulation under hypoxic conditions are associated with fibrin formation in IPE, representing advanced pleural inflammatory progress in children with pneumonia.
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Affiliation(s)
- Chih-Yung Chiu
- Division of Pediatric Pulmonology, Chang Gung Memorial Hospital at Linkou, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
| | - Mei-Ling Cheng
- Department of Medical Biotechnology and Laboratory Science and Healthy Aging Research Center , Chang Gung University , Taoyuan 333 , Taiwan
| | - Kin-Sun Wong
- Division of Pediatric Pulmonology, Chang Gung Memorial Hospital at Linkou, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
| | - Shen-Hao Lai
- Division of Pediatric Pulmonology, Chang Gung Memorial Hospital at Linkou, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
| | - Meng-Han Chiang
- Department of Medical Imaging and Intervention, Imaging Core Laboratory, Institute for Radiological Research, and Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Imaging Core Laboratory, Institute for Radiological Research, and Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
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25
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Harel-Sterling M, Diallo M, Santhirakumaran S, Maxim T, Tessaro M. Emergency Department Resource Use in Pediatric Pneumonia: Point-of-Care Lung Ultrasonography versus Chest Radiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:407-414. [PMID: 30027608 DOI: 10.1002/jum.14703] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/16/2018] [Accepted: 05/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Point-of-care lung ultrasonography (US) is an alternative to chest radiography for imaging of suspected community-acquired pneumonia (CAP) in children. We compared pediatric emergency department (ED) time metrics between children who received point-of-care lung US versus chest radiography. Secondary objectives were comparisons of health system costs and other resources in these imaging groups. METHODS This work was a retrospective matched cohort study of children aged 0 to 18 years in an academic urban pediatric ED who were imaged for suspected CAP with either point-of-care lung US or chest radiography. RESULTS A total of 202 patients (101 in each group) were included in the study. The point-of-care lung US group spent a mean of 75.9 (SE, 14.3) minutes less from physician assessment to discharge (P < .0001) and 60.9 (SE, 18.1) minutes less in the overall ED length of stay (P = .0008). Physician billings and facility fees were both significantly lower (P < .0001) in the point-of-care lung US group, for a mean health systems savings of CAN$187.1 (SE, CAN$21.9). CONCLUSIONS In children undergoing imaging for suspected CAP in our pediatric ED, point-of-care lung US by pediatric emergency medicine physicians was associated with decreased time and cost compared with chest radiography.
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Affiliation(s)
- Maya Harel-Sterling
- Department of Pediatrics, Division of Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mamadou Diallo
- Department of Pediatrics, Division of Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sabeena Santhirakumaran
- Department of Pediatrics, Division of Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Timea Maxim
- Department of Pediatrics, Division of Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark Tessaro
- Department of Pediatrics, Division of Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
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Moral L, Martín I, Fernández A, Cárdenas P, Toral T. Lung hypoperfusion in children with complicated pneumonia may be assessed by Doppler ultrasound of the main pulmonary arteries. CLINICAL RESPIRATORY JOURNAL 2019; 13:125-128. [PMID: 30610756 DOI: 10.1111/crj.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/26/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Luis Moral
- Pediatric Allergy and Respiratory Unit, Alicante University General Hospital, Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL - FISABIO Foundation), Alicante, Spain
| | - Ismael Martín
- Pediatric Cardiology Unit, Alicante University General Hospital, Alicante, Spain
| | - Ana Fernández
- Pediatric Cardiology Unit, Alicante University General Hospital, Alicante, Spain
| | - Paola Cárdenas
- Department of Pediatrics, Alicante University General Hospital, Alicante, Spain
| | - Teresa Toral
- Pediatric Allergy and Respiratory Unit, Alicante University General Hospital, Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL - FISABIO Foundation), Alicante, Spain
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27
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Dean P, Florin TA. Factors Associated With Pneumonia Severity in Children: A Systematic Review. J Pediatric Infect Dis Soc 2018; 7:323-334. [PMID: 29850828 PMCID: PMC6454831 DOI: 10.1093/jpids/piy046] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/02/2018] [Indexed: 12/25/2022]
Abstract
Community-acquired pneumonia in children is associated with significant morbidity and mortality; however, data are limited in predicting which children will have negative outcomes, including clinical deterioration, severe disease, or development of complications. The Pediatric Infectious Diseases Society/Infectious Diseases Society of America (PIDS/IDSA) pediatric pneumonia guideline includes criteria that were modified from adult criteria and define pneumonia severity to assist with resource allocation and site-of-care decision-making. However, the PIDS/IDSA criteria have not been formally developed or validated in children. Definitions for mild, moderate, and severe pneumonia also vary across the literature, further complicating the development of standardized severity criteria. This systematic review summarizes (1) the current state of the evidence for defining and predicting pneumonia severity in children as well as (2) emerging evidence focused on risk stratification of children with pneumonia.
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Affiliation(s)
- Preston Dean
- Cincinnati Children’s Hospital Medical Center Residency Training Program, Cincinnati Children’s Hospital Medical Center, Ohio,Corresponding Author: Preston Dean, MD, 3333 Burnet Ave, MLC 5018, Cincinnati, OH 45229. E-mail:
| | - Todd A Florin
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical, Ohio,Department of Pediatrics, University of Cincinnati College of Medicine, Ohio
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28
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Hahn A, Heffren J, Abo A. Improving Evidence Based Care of Community Acquired Pneumonia in Children. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Masters IB, Isles AF, Grimwood K. Necrotizing pneumonia: an emerging problem in children? Pneumonia (Nathan) 2017; 9:11. [PMID: 28770121 PMCID: PMC5525269 DOI: 10.1186/s41479-017-0035-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In children, necrotizing pneumonia (NP) is an uncommon, severe complication of pneumonia. It is characterized by destruction of the underlying lung parenchyma resulting in multiple small, thin-walled cavities and is often accompanied by empyema and bronchopleural fistulae. REVIEW NP in children was first reported in children in 1994, and since then there has been a gradual increase in cases, which is partially explained by greater physician awareness and use of contrast computed tomography (CT) scans, and by temporal changes in circulating respiratory pathogens and antibiotic prescribing. The most common pathogens detected in children with NP are pneumococci and Staphylococcus aureus. The underlying disease mechanisms are poorly understood, but likely relate to multiple host susceptibility and bacterial virulence factors, with viral-bacterial interactions also possibly having a role. Most cases are in previously healthy young children who, despite adequate antibiotic therapy for bacterial pneumonia, remain febrile and unwell. Many also have evidence of pleural effusion, empyema, or pyopneumothorax, which has undergone drainage or surgical intervention without clinical improvement. The diagnosis is generally made by chest imaging, with CT scans being the most sensitive, showing loss of normal pulmonary architecture, decreased parenchymal enhancement and multiple thin-walled cavities. Blood culture and culture and molecular testing of pleural fluid provide a microbiologic diagnosis in as many as 50% of cases. Prolonged antibiotics, draining pleural fluid and gas that causes mass effects, and maintaining ventilation, circulation, nutrition, fluid, and electrolyte balance are critical components of therapy. Despite its serious nature, death is uncommon, with good clinical, radiographic and functional recovery achieved in the 5-6 months following diagnosis. Increased knowledge of NP's pathogenesis will assist more rapid diagnosis and improve treatment and, ultimately, prevention. CONCLUSION It is important to consider that our understanding of NP is limited to individual case reports or small case series, and treatment data from randomized-controlled trials are lacking. Furthermore, case series are retrospective and usually confined to single centers. Consequently, these studies may not be representative of patients in other locations, especially when allowing for temporal changes in pathogen behaviour and differences in immunization schedules and antibiotic prescribing practices.
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Affiliation(s)
- I. Brent Masters
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Alan F. Isles
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Gold Coast campus, Griffith University, Building G40, Southport Gold Coast, QLD Australia
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport Gold Coast, QLD Australia
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30
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Yilmaz HL, Özkaya AK, Sarı Gökay S, Tolu Kendir Ö, Şenol H. Point-of-care lung ultrasound in children with community acquired pneumonia. Am J Emerg Med 2017; 35:964-969. [DOI: 10.1016/j.ajem.2017.01.065] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 01/18/2023] Open
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31
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Chen IC, Lin MY, Liu YC, Cheng HC, Wu JR, Hsu JH, Dai ZK. The role of transthoracic ultrasonography in predicting the outcome of community-acquired pneumonia in hospitalized children. PLoS One 2017; 12:e0173343. [PMID: 28301494 PMCID: PMC5354295 DOI: 10.1371/journal.pone.0173343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 02/20/2017] [Indexed: 11/18/2022] Open
Abstract
CONCLUSION TUS findings of fluid bronchogram, multifocal involvement, and pleural effusion were associated with adverse outcomes, including longer hospital stay, ICU admission, and tube thoracotomy in hospitalized CAP children. Therefore, TUS is a novel tool for prognostic stratifications of CAP in hospitalized children.
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Affiliation(s)
- I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ching Liu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsiao-Chi Cheng
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jiunn-Ren Wu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (JHH); (ZKD)
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (JHH); (ZKD)
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Stelle KA, Mornand A, Bajwa N, Vidal I, Anooshiravani M, Kanavaki A, Argiroffo CB, Blanchon S. Should Empyema with or without Necrotizing Pneumonia in Children Be Managed Differently? Health (London) 2017. [DOI: 10.4236/health.2017.92014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Andronikou S, Goussard P, Sorantin E. Computed tomography in children with community-acquired pneumonia. Pediatr Radiol 2017; 47:1431-1440. [PMID: 29043419 PMCID: PMC5608781 DOI: 10.1007/s00247-017-3891-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/27/2017] [Accepted: 05/04/2017] [Indexed: 11/27/2022]
Abstract
Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality of choice. Computed tomography (CT) on the other hand, is not currently a first-line imaging tool for children with suspected uncomplicated community-acquired pneumonia and is largely reserved for when complications of pneumonia are suspected or there is difficulty in differentiating pneumonia from other pathology. This review outlines the situations where CT needs to be considered in children with pneumonia, describes the imaging features of the parenchymal and pleural complications of pneumonia, discusses how CT may have a wider role in developing countries where human immunodeficiency virus (HIV) and tuberculosis are prevalent, makes note of the role of CT scanning for identifying missed foreign body aspiration and, lastly, addresses radiation concerns.
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Affiliation(s)
- Savvas Andronikou
- Department of Paediatric Radiology, Bristol Royal Hospital for Children and the University of Bristol, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
- Department of Radiology, University of Cape Town, Cape Town, South Africa.
| | - Pierre Goussard
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Erich Sorantin
- Department of Radiology, Medical University Graz, Graz, Austria
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34
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Mathew JL. Comparison of Lung Ultrasonography and Chest Radiography for Diagnosis of Childhood Pneumonia: Evidence based Medicine Viewpoint. Indian Pediatr 2016; 53:1007-1011. [PMID: 27889730 DOI: 10.1007/s13312-016-0977-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Kaiser Ururahy Nunes Fonseca E, do Amaral E Castro A, Sameshima YT. Emergency Thoracic US. Radiographics 2016; 36:2238. [PMID: 27831841 DOI: 10.1148/rg.2016160152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Adham do Amaral E Castro
- Department of Imaging, Hospital Israelita Albert Einstein, Av Albert Einstein 627, Sao Paulo, SP 05652-900, Brazil
| | - Yoshino Tamaki Sameshima
- Department of Imaging, Hospital Israelita Albert Einstein, Av Albert Einstein 627, Sao Paulo, SP 05652-900, Brazil
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Abstract
PURPOSE OF REVIEW Point of care ultrasound continues to become more prevalent in the diagnosis and management of many disease states. In this review, we focus on the use of bedside lung ultrasound (LUS) in the diagnosis of pneumonia. We describe the sonographic findings associated with pneumonia and the recent literature exploring its use in different settings and patient populations. RECENT FINDINGS The limited sensitivity of chest radiography in the diagnosis of pneumonia has been well described. Ultrasound is an attractive option because of its low cost, lack of ionizing radiation, portability, and repeatability. An alveolar or focal interstitial pattern has been described as the usual sonographic findings in pneumonia. Multiple studies have compared LUS with chest radiography in pneumonia, and have shown that LUS is at least equivalent, and in many instances superior, to chest radiography. SUMMARY Point of care LUS is an invaluable tool in the diagnosis of multiple pulmonary conditions, including pneumonia. Its use in real time with clinical correlation makes it an ideal tool for rapid diagnosis, especially in situations with unstable patients or in low-resource settings.
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Abstract
OBJECTIVE Radiographic imaging of the pediatric chest presents several unique challenges and nuances, stemming from congenital variants and pathologic processes specific to this population. Errors in interpretation may lead to inappropriate further imaging, incurring additional radiation exposure and cost, as well as psychologic effects on the patients and their families. CONCLUSION Here, we aim to highlight some common and less common pitfalls in pediatric chest radiography, as well as some tools for avoiding potential mistakes.
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38
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Liu SS, Song LJ, Meng FZ, Peng L, Liu YH. [Early predictors of necrotizing pneumonia in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:391-395. [PMID: 27165585 PMCID: PMC7390365 DOI: 10.7499/j.issn.1008-8830.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/07/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the early predictors of necrotizing pneumonia in children. METHODS The clinical data of 43 children with necrotizing pneumonia and 83 children with lobar pneumonia were retrospectively analyzed. Sex, age, the number of days with fever, laboratory examination results, and bronchoscopic findings were compared between the two groups. The multiple logistic regression analysis was used to identify the early predictors of necrotizing pneumonia. RESULTS The necrotizing pneumonia group had a higher percentage of girls than the lobar pneumonia group (P<0.05). Compared with the lobar pneumonia group, the necrotizing pneumonia group had a larger number of days with fever, a higher peripheral blood white blood cell count (WBC), a higher percentage of neutrophils (NE%), and higher serum levels of high-sensitivity C-reactive protein (hs-CRP), albumin (Alb), and lactate dehydrogenase (LDH) (P<0.05). The necrotizing pneumonia group also had higher percentages of children with a large amount of sputum bolt under a bronchoscope which needed to be removed with biopsy forceps and children with rice-water-like bronchoalveolar lavage fluid (P<0.05). The multiple logistic regression analysis showed that being a female, the presence of sputum bolt under a bronchoscope which needed to be removed with biopsy forceps, the number of days with fever, WBC, hs-CRP, and LDH were independent predictors of necrotizing pneumonia. The receiver operating characteristic curve analysis showed that the cut-off values of the latter 4 predictors were 18.5 d, 15.1×10(9)/L, 121.5 mg/L, and 353.5 U/L, respectively. CONCLUSIONS Increased WBC (≥15.1×10(9)/L), increased hs-CRP (≥121.5 mg/L), increased serum LDH (≥353.5 U/L), and the presence of sputum bolt under a bronchoscope which needs to be removed with biopsy forceps and rice-water-like bronchoalveolar lavage fluid may be the early predictors of necrotizing pneumonia in children.
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Affiliation(s)
- Shuai-Shuai Liu
- Department of Pediatric Respiratory Diseases, First Hospital of Jilin University, Changchun 130021, China.
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39
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Liu SS, Song LJ, Meng FZ, Peng L, Liu YH. [Early predictors of necrotizing pneumonia in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:391-5. [PMID: 27165585 PMCID: PMC7390365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/07/2016] [Indexed: 08/01/2024]
Abstract
OBJECTIVE To investigate the early predictors of necrotizing pneumonia in children. METHODS The clinical data of 43 children with necrotizing pneumonia and 83 children with lobar pneumonia were retrospectively analyzed. Sex, age, the number of days with fever, laboratory examination results, and bronchoscopic findings were compared between the two groups. The multiple logistic regression analysis was used to identify the early predictors of necrotizing pneumonia. RESULTS The necrotizing pneumonia group had a higher percentage of girls than the lobar pneumonia group (P<0.05). Compared with the lobar pneumonia group, the necrotizing pneumonia group had a larger number of days with fever, a higher peripheral blood white blood cell count (WBC), a higher percentage of neutrophils (NE%), and higher serum levels of high-sensitivity C-reactive protein (hs-CRP), albumin (Alb), and lactate dehydrogenase (LDH) (P<0.05). The necrotizing pneumonia group also had higher percentages of children with a large amount of sputum bolt under a bronchoscope which needed to be removed with biopsy forceps and children with rice-water-like bronchoalveolar lavage fluid (P<0.05). The multiple logistic regression analysis showed that being a female, the presence of sputum bolt under a bronchoscope which needed to be removed with biopsy forceps, the number of days with fever, WBC, hs-CRP, and LDH were independent predictors of necrotizing pneumonia. The receiver operating characteristic curve analysis showed that the cut-off values of the latter 4 predictors were 18.5 d, 15.1×10(9)/L, 121.5 mg/L, and 353.5 U/L, respectively. CONCLUSIONS Increased WBC (≥15.1×10(9)/L), increased hs-CRP (≥121.5 mg/L), increased serum LDH (≥353.5 U/L), and the presence of sputum bolt under a bronchoscope which needs to be removed with biopsy forceps and rice-water-like bronchoalveolar lavage fluid may be the early predictors of necrotizing pneumonia in children.
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Affiliation(s)
- Shuai-Shuai Liu
- Department of Pediatric Respiratory Diseases, First Hospital of Jilin University, Changchun 130021, China.
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Abstract
Community-acquired pneumonia (CAP) is the most common acute infectious cause of death in children worldwide. Consequently, research into the epidemiology, diagnosis, treatment, and prevention of pediatric CAP spans the translational research spectrum. Herein, we aim to review the most significant findings reported by investigators focused on pediatric CAP research that has been reported in 2014 and 2015. Our review focuses on several key areas relevant to the clinical management of CAP. First, we will review recent advances in the understanding of CAP epidemiology worldwide, including the role of vaccination in the prevention of pediatric CAP. We also report on the expanding role of existing and emerging diagnostic technologies in CAP classification and management, as well as advances in optimizing antimicrobial use. Finally, we will review CAP management from the policy and future endeavors standpoint, including the influence of clinical practice guidelines on clinician management and patient outcomes, and future potential research directions that are in the early stages of investigation.
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