Elsevier

European Journal of Radiology

Volume 83, Issue 9, September 2014, Pages 1507-1518
European Journal of Radiology

Potential of ultrasound in the pediatric chest

https://doi.org/10.1016/j.ejrad.2014.04.011Get rights and content

Abstract

Ultrasound (US) of chest, even with inherent limitations of the US beam and air, has been useful in many pediatric chest conditions. It has extended its role and is now widely used by many subspecialists in medicine. This review article will cover techniques, indications, and applications of chest US in neonates, infants and children, including also different common as well as some rare and modern aspects and applications, such as pleural effusion, pneumothorax, pulmonary lesions, mediastinum, diaphragm, and chest wall. Other related imaging modalities are also briefly discussed.

Introduction

In the past US seemed to be an inappropriate modality for the chest where the bony cage and the aerated lung limit US transmission. However, US has had its established role for a long time in the chest wall, the breast, the diaphragm, in echocardiography, and for pleural effusions – which all can be accessed without intervening aerated lung. In infants and young children with the presence of a large thymus gland, the mediastinum can be evaluated by US using this window. During the past decade, the extended use of chest US for evaluation of the pleura including pneumothorax and the lung has been established. The practice of chest US today is not only static evaluation of thoracic structures but also assessment of dynamic processes, not only using conventional echo based images for interpretation but also artifacts. US guidance for central venous access and for biopsy or aspiration of mediastinal, pleural, and pulmonary lesion is also increasing, in both adults and children. And US of the chest is now being performed by many subspecialties, including (pediatric) radiologists, sonographers, pediatricians and neonatologists, physicians in (pediatric) emergency department and (pediatric or neonatal) intensive care unit, (pediatric) pulmonologists, and (pediatric) anesthesiologists.

Section snippets

Technique of chest ultrasound

Type and frequency of the US transducer is selected considering patient's size and age, the site of the US approach, and the depth of a lesion. For the chest wall, the pleura and the subpleural space high-frequency (5–15 MHz) linear (or small convex) transducers are preferred. For the diaphragm or peridiaphragmatic lesions, convex transducers with lower frequencies (3–6 MHz) are used – often with a transabdominal approach. For accessing a lesion through a small US window, a sector transducer may

Indications of chest ultrasound

Indications of chest US widely vary depending on the patient's disease and condition as well as regional imaging concepts and needs. Common reasons to consider a chest US – besides echocardiographic queries – are:

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    to evaluate a chest wall lesion

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    to confirm and characterize pleural effusions

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    to detect pleural thickening and/or a pleural tumor

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    to assess an abnormal high or lobulated diaphragm as well as diaphragmatic motion

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    to assess an radiologically opaque lung

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    to confirm pulmonary consolidations and

Ultrasound for pleural effusions

US is a very good modality for detection of pleural effusions even if of very small amount. It is the best option to classify effusion into simple or complex, i.e., free of echoes, or loculated and full of floating debris echoes, respectively. US is even more sensitive than a lateral-decubitus chest radiograph in detection of small pleural effusions, if performed properly, best in an upright sitting position evaluating the base of the lung with a high resolution linear transducer [1]. The

Conclusion

A wide variety of pediatric chest conditions can be properly assessed by US. Chest US can be used as a primary or already diagnostic modality, as a complementary imaging modality in equivocal chest film findings, or as an additional tool for guiding interventions. Chest US is increasingly performed by many subspecialties, however, this requires adequate and extended knowledge of all who apply this technique. Nevertheless, in terms of the ALARA principle, chest US should be promoted in children

Conflict of interest statement

None declared.

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