Study On The Lung Ultrasonic Characteristics Of Children Community Acquired Pneumonia

Objective:To investigate the ultrasonographic characteristics and clinical application value of Lung ultrasound(LUS)in children with community acquired pneumonia(CAP).Methods:Selection of Qilu Hospital of Shandong University(Qingdao)outpatient department of Pediatrics 207 cases of children with suspected CAP were examined by LUS,chest X-ray(CXR)and serum inflammatory indexes,divided into A group(28 days-1year,70 cases),B group(1-6years,n = 99),C group(6-14 years,n = 38),and the patients reexamined LUS and serum inflammatory indexes at 7days and 14 days after diagnosis.The ultrasonographic features of LUS were used for clinically diagnosed CAP,and CXR images were also collected to compare the accuracy and consistency of LUS and CXR in the diagnosis of CAP to establish the diagnostic criteria of this study.In addition,the serum inflammatory indexes of children with CAP were also obtained,and the changes of LUS sonography and the relationship with inflammatory indexes,clinical symptoms and signs were analyzed.Results:(1)CAP sonographic features of LUS A total of 207 cases were enrolled,clinically confirmed in CAP155 cases,excluding 52 cases.LUS was positive in 147 cases,the sonographic features: multiple B lines or fused B lines in 142 cases(96.6%),pleural line abnormalities(thickening,blurred and broken,not continuous)41 cases(27.9%),hypoechoic areas or liver like area in 97 cases(66%),with air bronchogram in 80 cases(54.4%),pleural effusion in 31 cases(21.1%),there was no significant difference in different age groups.Multiple B lines or fused B lines,pleural line abnormalities,hypoechoic areas or liver like area were important signs of CAP diagnosis.(2)Clinical value of LUS in the diagnosis of CAP Multiple B lines or fused B lines,pleural line abnormalities,hypoechoic areas or liver like areas were the LUS diagnostic criteria of CAP,LUS diagnosis of CAP147 cases,missed diagnosis of 8 cases,misdiagnosis of 3 cases.The sensitivity was 94.8%,specificity was 94.2%,false positive was 5.8%,false negative was 5.2%,positive predictive value was 98% and negative predictive value was 86%.There was no significant difference between different age groups.CXR diagnosis of 124 cases,missed diagnosis of 31 cases,and misdiagnosed of 5 cases.The sensitivity was 80%,specificity was 90.4%,false positive was 9.6%,false negative was 20%,positive predictive value was 96.1% and negative predictive value was 60.3%.There was no significant difference between different age groups.The sensitivity of LUS and CXR in the diagnosis of CAP was statistically significant(?2=13.08,P<0.01),and there was no significant difference between the two groups(?2=0.13,P>0.05).LUS and CXR diagnosis were positive in 123 cases,diagnostic negative in 51 cases;LUS diagnosis was positive,CXR diagnosis was negative in 27 cases;ultrasound diagnosis was negative,CXR diagnosis was positive in 6 cases.The concordance rate of LUS and CXR was(P o)84.1%,Kappa was 0.64,and LUS and CXR had good consistency in diagnosing CAP.There were no significant differences in sensitivity,specificity and consistency among different age groups.(3)The change of LUS sonogram Multiple B lines or fused B lines,hypoechoic areas or liver like areas were instead of pleural line abnormalities,pleural line abnormalities recovered slowly,and there were still some cases of pleural line abnormality in 14 days.Early absorption of pleural effusion was slower,and later absorption was faster.(4)With the decrease of serum inflammatory indexes,the symptoms and signs were relieved,and the maximum sectional area of hypoechoic area or liver like area gradually decreased and disappeared.Conclusions:(1)LUS images of children with CAP were characteristic.Multiple B lines or fused B lines,and abnormal pleural lines,hypoechoic areas or liver like areas were important signs in the diagnosis of CAP in children.(2)LUS and CXR had better consistency in diagnosis of CAP in children,and the sensitivity of LUS in diagnosis of CAP in children was higher than that in CXR.(3)The maximum cross-sectional area of hypoechoic areas or liver like areas was consistent with the change trend of serum inflammatory indicators,symptoms and signs in CAP children,which could be used as an indicator of children's CAP disease assessment.(4)LUS had a good clinical value in the diagnosis of CAP in children.