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.

Thank you for the opportunity to respond to the issues raised by Nenna et al [...].

Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children.

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.

Comparison of lung ultrasound and chest X-ray findings in children with bronchiolitis.

Respiratory syncytial virus is the main pathogen responsible for bronchiolitis. Usually, there is no indication to perform diagnostic imaging or run laboratory tests in patients with bronchiolitis since the diagnosis is based on the clinical presentation. Chest radiogram can be useful in severe cases. So far, lung ultrasound has not been considered as an alternative in guidelines for imaging diagnosis of bronchiolitis. The aim of the study was to compare lung ultrasound and chest X-ray findings in children with bronchiolitis. In our study we retrospectively compared diagnostic imaging findings in children with confirmed respiratory syncytial virus infection. The study included 23 children aged 2 weeks to 24 months and 3 children older than 24 months. Chest X-ray showed lesions in only 4 cases, whereas ultrasound abnormalities were found in 21 patients. Pathologies revealed by chest X-ray were the same for all 4 cases and consisted of an enlarged hilus and peribronchial cuffing. Sonographic lesions included inflammatory consolidations larger than 10 mm in 11 patients, small consolidations (<10 mm diameter) in 8 patients, interstitial syndromes in 6 patients, and alveolar-interstitial syndromes in 11 patients. A small amount of pleural effusion was detected in 3 patients. Considering safety, short time of examination, high sensitivity in finding pleural effusion, small consolidations and signs of interstitial infiltrations, transthoracic lung ultrasound may be useful in the diagnosis of bronchiolitis.

Tracheobronchopathia osteochondroplastica - a 61-year-old female with middle lobe syndrome.

The authors present a case of a 61-year-old female patient suffering from tracheobronchopathia osteochondroplastica (TBO). Etiology of this unit is uncertain. TBO is characterised by presence of multiple nodules of various size, situated in the submucosa of the trachea and major bronchi. The course is usually benign, until lesion obstructs the bronchial lumen. In the presented case, occluded middle lobe bronchi resulted in peripheral atelectasis of the lung.