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Pederiva F, Rothenberg SS, Hall N, Ijsselstijn H, Wong KKY, von der Thüsen J, Ciet P, Achiron R, Pio d'Adamo A, Schnater JM. Congenital lung malformations. Nat Rev Dis Primers 2023; 9:60. [PMID: 37919294 DOI: 10.1038/s41572-023-00470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
Congenital lung malformations (CLMs) are rare developmental anomalies of the lung, including congenital pulmonary airway malformations (CPAM), bronchopulmonary sequestration, congenital lobar overinflation, bronchogenic cyst and isolated congenital bronchial atresia. CLMs occur in 4 out of 10,000 live births. Postnatal presentation ranges from an asymptomatic infant to respiratory failure. CLMs are typically diagnosed with antenatal ultrasonography and confirmed by chest CT angiography in the first few months of life. Although surgical treatment is the gold standard for symptomatic CLMs, a consensus on asymptomatic cases has not been reached. Resection, either thoracoscopically or through thoracotomy, minimizes the risk of local morbidity, including recurrent infections and pneumothorax, and avoids the risk of malignancies that have been associated with CPAM, bronchopulmonary sequestration and bronchogenic cyst. However, some surgeons suggest expectant management as the incidence of adverse outcomes, including malignancy, remains unknown. In either case, a planned follow-up and a proper transition to adult care are needed. The biological mechanisms through which some CLMs may trigger malignant transformation are under investigation. KRAS has already been confirmed to be somatically mutated in CPAM and other genetic susceptibilities linked to tumour development have been explored. By summarizing current progress in CLM diagnosis, management and molecular understanding we hope to highlight open questions that require urgent attention.
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Affiliation(s)
- Federica Pederiva
- Paediatric Surgery, "F. Del Ponte" Hospital, ASST Settelaghi, Varese, Italy.
| | - Steven S Rothenberg
- Department of Paediatric Surgery, Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Nigel Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hanneke Ijsselstijn
- Department of Paediatric Surgery and Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Kenneth K Y Wong
- Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Pierluigi Ciet
- Departments of Radiology and Nuclear Medicine and Respiratory Medicine and Allergology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, The Chaim Sheba Medical Center Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adamo Pio d'Adamo
- Laboratory of Medical Genetics, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - J Marco Schnater
- Department of Paediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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2
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Lung Ultrasound to Diagnose Pneumonia in Neonates with Fungal Infection. Diagnostics (Basel) 2022; 12:diagnostics12081776. [PMID: 35892488 PMCID: PMC9331912 DOI: 10.3390/diagnostics12081776] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/04/2022] [Accepted: 07/20/2022] [Indexed: 12/25/2022] Open
Abstract
With the improvement in survival rates of low-birthweight and very premature infants, neonatal fungal infection, especially fungal pneumonia, is becoming more and more common, but the diagnosis is always challenging. Recently, lung ultrasound (LUS) has been used to diagnose pneumonia in newborn infants, but not fungal pneumonia. This paper summarizes the ultrasonographic features of seven cases of neonatal fungal pneumonia, such as lung consolidation with air bronchograms, shred signs, lung pulse, pleural line abnormalities, and different kinds of B-lines. It was confirmed that LUS plays an important role in the diagnosis of fungal pneumonia in newborn infants.
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3
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Utilidad de la ecografía pulmonar en el diagnóstico y seguimiento de la patología respiratoria neonatal. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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4
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Fernández LR, Hernández RG, Guerediaga IS, Gato JM, Fanjul JR, Bilbao VA, Quintela PA, Ojembarrena AA. Usefulness of lung ultrasound in the diagnosis and follow-up of respiratory diseases in neonates. An Pediatr (Barc) 2022; 96:252.e1-252.e13. [DOI: 10.1016/j.anpede.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022] Open
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5
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Wang J, Wei H, Chen H, Wan K, Mao R, Xiao P, Chang X. Application of ultrasonography in neonatal lung disease: An updated review. Front Pediatr 2022; 10:1020437. [PMID: 36389379 PMCID: PMC9640768 DOI: 10.3389/fped.2022.1020437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
Lung disease is often life-threatening for both preterm and term newborns. Therefore, an accurate and rapid diagnosis of lung diseases in newborns is crucial, as management strategies differ with different etiologies. To reduce the risk of radiation exposure derived from the conventionally used chest x-ray as well as computed tomography scans, lung ultrasonography (LUS) has been introduced in clinical practice to identify and differentiate neonatal lung diseases because of its radiation-free characteristic, convenience, high accuracy, and low cost. In recent years, it has been proved that LUS exhibits high sensitivity and specificity for identifying various neonatal lung diseases. Here, we offer an updated review of the applications of LUS in neonatal lung diseases based on the reports published in recent years (2017 to present).
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Affiliation(s)
- Jin Wang
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Hongjuan Wei
- Department of Neonatology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Hui Chen
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Ke Wan
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Ruifeng Mao
- School of Life Sciences, Huaiyin Normal University, Huai'an, China
| | - Peng Xiao
- Department of Dermatology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Xin Chang
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
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6
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Liu X, Si S, Guo Y, Wu H. Limitations of Bedside Lung Ultrasound in Neonatal Lung Diseases. Front Pediatr 2022; 10:855958. [PMID: 35558371 PMCID: PMC9086677 DOI: 10.3389/fped.2022.855958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Lung ultrasound is a technique that has rapidly developed in recent years. It is a low-cost, radiation-free, and easy-to-operate tool that can be repeatedly performed at the bedside. Compared to chest X-ray, lung ultrasound has high sensitivity and specificity in the diagnosis of neonatal respiratory distress syndrome, transient tachypnoea of newborns and pneumothorax. Lung ultrasound has been widely used in neonatal intensive care units. However, due to the physical barriers of air, where ultrasonic waves cannot pass and therefore reflection artifacts occur, it has limitations in some other lung diseases and cannot fully substitute for chest X-rays or CT/MRI scanning. This review describes these limitations in detail and highlights that if clinical symptoms are not effectively alleviated after medical treatment or the clinical presentation is not compatible with the ultrasound appearances, then chest X-rays or CT/MRI scanning should be performed to avoid misdiagnosis and mistreatment.
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Affiliation(s)
- Xiaolei Liu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Shuyu Si
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Yiyi Guo
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
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Ammirabile A, Buonsenso D, Di Mauro A. Lung Ultrasound in Pediatrics and Neonatology: An Update. Healthcare (Basel) 2021; 9:1015. [PMID: 34442152 PMCID: PMC8391473 DOI: 10.3390/healthcare9081015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 12/24/2022] Open
Abstract
The potential role of ultrasound for the diagnosis of pulmonary diseases is a recent field of research, because, traditionally, lungs have been considered unsuitable for ultrasonography for the high presence of air and thoracic cage that prevent a clear evaluation of the organ. The peculiar anatomy of the pediatric chest favors the use of lung ultrasound (LUS) for the diagnosis of respiratory conditions through the interpretation of artefacts generated at the pleural surface, correlating them to disease-specific patterns. Recent studies demonstrate that LUS can be a valid alternative to chest X-rays for the diagnosis of pulmonary diseases, especially in children to avoid excessive exposure to ionizing radiations. This review focuses on the description of normal and abnormal findings during LUS of the most common pediatric pathologies. Current literature demonstrates usefulness of LUS that may become a fundamental tool for the whole spectrum of lung pathologies to guide both diagnostic and therapeutic decisions.
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Affiliation(s)
- Angela Ammirabile
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, “Aldo Moro” University of Bari, 70100 Bari, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonio Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Via Conversa 12, 10135 Margherita di Savoia, Italy;
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Lung Ultrasound and Clinical Progression of Acute Bronchiolitis: A Prospective Observational Single-Center Study. MEDICINA-LITHUANIA 2020; 56:medicina56060314. [PMID: 32604769 PMCID: PMC7353897 DOI: 10.3390/medicina56060314] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Recent literature suggests that lung ultrasound might have a role in the diagnosis and management of bronchiolitis. The aim of the study is to evaluate the relationship between an ultrasound score and the clinical progression of bronchiolitis: need for supplemental oxygen, duration of oxygen therapy and hospital stay. Materials and Methods: This was a prospective observational single-center study, conducted in a pediatric unit during the 2017–2018 epidemic periods. All consecutive patients admitted with clinical signs of acute bronchiolitis, but without the need for supplemental oxygen, underwent a lung ultrasound in the first 24 h of hospital care. The lung involvement was graded based on the ultrasound score. During clinical progression, need for supplemental oxygen, duration of oxygen therapy and duration of hospital stay were recorded. Results: The final analysis included 83 patients, with a mean age of 4.5 ± 4.1 months. The lung ultrasound score in patients that required supplemental oxygen during hospitalization was 4.5 ± 1.7 (range: 2.0–8.0), different from the one of the not supplemented infants (2.5 ± 1.8; range: 0.0–6.0; p < 0.001). Ultrasound score was associated with the need for supplemental oxygen (OR = 2.2; 95% CI = 1.5–3.3; p < 0.0001). Duration of oxygen therapy was not associated with LUS score (p > 0.05). Length of hospital stay (coef. = 0.5; 95% CI = 0.2–0.7; p < 0.0001) correlates with LUS score. Conclusion: Lung ultrasound score correlates with the need of supplemental oxygen and length of hospital stay in infants with acute bronchiolitis.
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9
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Di Mauro A, Ammirabile A, Quercia M, Panza R, Capozza M, Manzionna MM, Laforgia N. Acute Bronchiolitis: Is There a Role for Lung Ultrasound? Diagnostics (Basel) 2019; 9:E172. [PMID: 31683953 PMCID: PMC6963954 DOI: 10.3390/diagnostics9040172] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Viral bronchiolitis is a common cause of lower respiratory tract infection in the first year of life, considered a health burden because of its morbidity and costs. Its diagnosis is based on history and physical examination and the role of radiographic examination is limited to atypical cases. Thus far, Lung Ultrasound (LUS) is not considered in the diagnostic algorithm for bronchiolitis. METHODS PubMed database was searched for trials reporting on lung ultrasound examination and involving infants with a diagnosis of bronchiolitis. RESULTS Eight studies were suitable. CONCLUSIONS This review analyzed the current evidence about the potential usefulness of LUS in the clinical management of bronchiolitis. Literature supports a peculiar role of LUS in the evaluation of the affected children, considering it as a reliable imaging test that could benefit the clinical management of bronchiolitis.
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Affiliation(s)
- Antonio Di Mauro
- Department of Biomedical Science and Human Oncology, "Aldo Moro" University of Bari, 70100 Bari, Italy.
| | - Angela Ammirabile
- Department of Biomedical Science and Human Oncology, "Aldo Moro" University of Bari, 70100 Bari, Italy.
| | - Michele Quercia
- Department of Biomedical Science and Human Oncology, "Aldo Moro" University of Bari, 70100 Bari, Italy.
| | - Raffaella Panza
- Department of Biomedical Science and Human Oncology, "Aldo Moro" University of Bari, 70100 Bari, Italy.
| | - Manuela Capozza
- Department of Biomedical Science and Human Oncology, "Aldo Moro" University of Bari, 70100 Bari, Italy.
| | - Mariano M Manzionna
- Unità Operativa Complessa, Pediatric and Neonatology, San Paolo Hospital, ASL BARI, 70100 Bari, Italy.
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology, "Aldo Moro" University of Bari, 70100 Bari, Italy.
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10
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Merli L, Nanni L, Curatola A, Pellegrino M, De Santis M, Silvaroli S, Paradiso FV, Buonsenso D. Congenital lung malformations: a novel application for lung ultrasound? J Ultrasound 2019; 24:349-353. [PMID: 31487034 DOI: 10.1007/s40477-019-00406-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/28/2019] [Indexed: 01/09/2023] Open
Abstract
Congenital lung malformations (CLMs) include a group of different disorders. With widespread use of antenatal ultrasonography (aUS) and increased use of pre-natal magnetic resonance imaging (MRI), CLMs are increasingly detected, nevertheless the best postnatal imaging approach is not yet well defined: newborns usually undergo several chest X-rays and eventually computed tomography to confirm the diagnosis. In this case series, we show lung ultrasound features of three different cases of congenital lung malformations, describing prenatal and postnatal images comparing different imaging techniques.
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Affiliation(s)
- L Merli
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Chirurgia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Nanni
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Chirurgia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Curatola
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M Pellegrino
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M De Santis
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Centro Studi per la Tutela della Salute della Madre e del Concepito, Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Silvaroli
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Chirurgia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F V Paradiso
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Chirurgia Pediatrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica-UOC Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Università Cattolica del Sacro Cuore, Rome, Italy.
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