LUS findings
Details about LUS features in acutely ill children are described
in Table 4. Table 4 shows, in particular the differences, of the
ultrasound features among acutely ill children , healthy infants
and children with bronchiolitis.
Short vertical artifacts were found in 100% of patients with
bronchiolitis and are present in 21.3% of healthy infants. According to
the data published by our study on the analysis of the ultrasound
pattern of healthy infants, short vertical artifacts are present during
the first 3 months of life in all lung regions and with the passing of
the months their presence decreases.2 In contrast, in
our study population (acutely ill children ), no patient presented
short vertical artifacts, thus with a significant statistical difference
(p <0.001) compared to bronchiolitis and healthy patients.
Long vertical artifacts are present in 100% of acutely ill
children with a statistically significant difference (p
<0.001), particularly compared to healthy patients.
But what is more important, regarding long vertical artifacts, for the
qualitative and / or semi quantitative analysis of sonographic
interstitial syndrome7,8,10,25 are the differences -
in the three groups of patients - of the characteristics and
distribution of long vertical artifacts in the different lung fields.
In particular
- 100% of acutely ill patients have multiple long vertical artifacts
with a significant difference (p <0.001), particularly
compared to healthy patients who have single long vertical artifacts in
70.6% of cases.
- Multiple vertical artifacts are 91.3% non-confluent inacutely ill children with a statistically significant difference
(p <0.001) compared to the other two groups.
- We found that in acutely ill children , the distribution of long
vertical artifacts occurs both ”without spared areas” (52.17% of
cases) and ”with spread areas” (47.83%). On the contrary, in
61% of healthy patients and in 100% of patients with bronchiolitis,
they distribute “with spared areas” in a less homogenous and more
densely-packed way. Therefore, also for this ultrasound results, we
found statistically significant differences (p <0.001).
- Another important result concerns the different distributions of
long vertical artifacts in the different lung fields explored, which is
statistically significant (p <0.001) in the three groups of
patients: in acutely ill children , we found a distribution
predominantly in the basal fields (86.96 %) and also multiple long
vertical artifacts are always bilaterally distributed (100%); on the
contrary, in 69.7% of healthy patients, unilateral distribution
prevails with diffusion in all fields explored (87.89% of cases); as
well as in patients with bronchiolitis in 100% of cases we find long
vertical artifacts widespread in all fields explored with a
predominantly unilateral (37.74%) or bilateral distribution with a
prevalent diffusion in the right and / or left lung (39.62%).
We analyzed the presence and distribution of anechoic pleural
effusion : it was found only in acutely ill children and in
particular in 73.91% of patients with a bilateral distribution in
41.19% of cases.
No acutely ill patients enrolled had supleural consolidations or
pleural line irregularities . A minority of acutely ill patients
(26.09%) had a globally regular pleural line with sporadic areas of
irregularity. Even in healthy newborns, no subpleural consolidations and
irregularities of the pleura line were found in any patient, on the
contrary in patients with bronchiolitis subpleural consolidations and
irregularities of the pleural line were found in 100% of patients.
Table 5 shows the differences in ultrasound results in the two groups ofacutely ill children with pro-BNP level lower and higher than
1000 pg / ml. For many of the ultrasound findings, there are no
statistically significant differences in the two groups. We found a
significant difference (p <0.001) in the distribution of long
vertical artifacts “with or without spared areas”. In particular, we
reconsidered that 100% of acutely ill patients with pro-BNP
<1000 pg / ml present a destruction of long vertical artifacts
“with spared areas”. Most children with pro-BNP <1000 belong
to the group of acutely ill children with systemic inflammatory
disease/sepsis in the absence of organic and / or functional damages in
the myocardium (Table 1 and Table 2). In 85.71% of cases of the
children belonging to the group with pro-BNP> 1000 pg / ml
(most of these belong to the heart disease group with or without
systemic inflammation/sepsis as shown in Table 1 and Table 2) vertical
artifacts are distributed homogeneously ”without spared areas ” (as from
early cardiogenic edema).
Table 6 shows the differences of the ultrasound features in the three
diagnostic categories of acutely ill children .