Value of high-frequency lung ultrasound to the diagnosis of community-acquired pneumonia in children
Objective To observe the characteristics of high-frequency lung ultrasound images in children with community-acquired pneumonia(CAP)and to evaluate the value of high-frequency lung ultrasound to the diagnosis of CAP in children.Methods A total of 197 children with suspected CAP were treated in the Second Affiliated Hospital of Xi'an Jiaotong University from October 2023 to January 2024.All patients received chest CT and high-frequency lung ultrasound within 48 h after admission.The clinical symptoms,infectious pathogens and lung ultrasound manifestations were recorded.Taking the chest CT findings as the gold standard for the diagnosis of pneumonia,197 children were divided into the pneumonia group(n=174)and the no-pneumonia group(n=23),and the rates of lung consolidation(tissue-like sign,shred sign),B-line and pleural effusion detected by ultrasound were compared between two groups.ROC curves were drawn to evaluate the efficiency of lung ultrasound findings on the diagnosis of CAP in children.Results In 197 children with suspected pneumonia,the clinical symptoms were fever in 183,and cough and expectoration in 165.In the pneumonia group,there were 111 of Mycoplasma pneumoniae infection,38 of Mycoplasma pneumoniae plus virus infection,5 of respiratory syncytial virus infection,8 of adenovirus infection,3 of influenza virus infection,and 9 cases of unknown pathogens infection.Among 197 cases,169 cases of lung consolidation were detected by high-frequency ultrasound,with the diameter of consolidation from 0.8 to 10.0 cm,irregular shape of consolidation,clear boundary between consolidation and normal lung tissue,static or dynamic bronchial insufflation sign,and blood flow signal filling in most consolidation areas,among whom there were 139 cases of tissue-like sign and 30 cases of shred sign;there were 151 cases of B-line,including 85 cases of discrete B-line and 66 cases of fusion B-line;11 cases were found pleural effusion.The detective rates of tissue-like sign,shred sign and B-line were higher in the pneumonia group(78.7％,16.7％,83.3％)than those in the no-pneumonia group(8.7％,4.3％,26.1％)(x2=53.582,4.495,37.197;all P values＜0.05),and there was no significant difference in the pleural effusion rate between two groups(6.3％vs.0)(x2=1.540,P=0.215).The AUC of lung consolidation(tissue-like sign,shred sign)for diagnosing CAP in children was 0.909(95％CI:0.851-0.967,P＜0.001),with a sensitivity of 86.2％and a specificity of 95.7％.The AUC of B-line was 0.786(95％CI:0.677-0.896,P＜0.001),with a sensitivity of 83.3％and a specificity of 73.9％.The AUC of lung consolidation plus B-line was 0.844(95％CI:0.735-0.952,P＜0.001),with a sensitivity of 94.8％and a specificity of 73.9％.Conclusion The detective rates of tissue-like sign,shred sign and B-line are high in children with CAP by high-frequency ultrasound,and the combined detection of them achieves a high diagnostic value for CAP in children.
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