First-line diagnosis of paediatric pneumonia in emergency: lung ultrasound (LUS) in addition to chest-X-ray (CXR) and its role in follow-up.

OBJECTIVE: The role of lung ultrasound (LUS) integrated with chest X-ray (CXR) for the first-line diagnosis of paediatric pneumonia; to define its role during the follow-up to exclude complications. METHODS: We performed a retrospective review of a cohort including 84 consecutive children (age range: 3-16 years; mean age: 6 years; 44 males, 40 females) with clinical signs of cough and fever. All the patients underwent CXR at admission integrated with LUS. Those positive at LUS were followed up with LUS until the complete resolution of the disease. RESULTS: CXR showed 47/84 pneumonic findings. LUS showed 60/84 pneumonic findings; 34/60 pneumonic findings had a typical pattern of lung consolidation; 26/60 pneumonic findings showed association of multiple B-lines, findings consistent with interstitial involvement, and small and hidden consolidations not achievable by CXR. One case was negative at LUS because of retroscapular location. 60 patients were followed up with LUS; 28/60 patients showed a complete regression of the disease; 23/60 patients had a significant decrease in size of consolidation; 9/60 patients showed disease stability or insignificant decrease in size, thus requiring adjunctive LUS examinations. CONCLUSION: LUS, integrated with CXR, revealed to be an accurate first-line technique to identify small pneumonic consolidations, especially for "CXR-occult" findings, and for early diagnosis of pleural effusion; furthermore, LUS follow-up allows complications to be verified and additional radiation exposures to be avoided. ADVANCES IN KNOWLEDGE: The effective role of LUS in the diagnosis and follow-up of lung consolidations and pleural effusions in paediatric patients in an emergency setting.