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Lung Ultrasonography Versus Chest X Ray for Diagnosing Pneumonia in Children with Fever and Respiratory Distress: A Prospective Blind Study
American Journal of Pediatrics
Volume 4, Issue 1, March 2018, Pages: 15-20
Received: Feb. 24, 2018; Accepted: Mar. 21, 2018; Published: Apr. 14, 2018
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Rania Salah El Zayat, Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Wael Abbass Bahbah, Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Waleed Abd Elfattah Mousa, Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Pneumonia is a major cause of morbidity and mortality in children especially in developing countaries. Lung ultrasonography (LUS) is an accepted safe diagnostic tool with many advantages over chest x-ray (CXR). The objective of this prospective observational study was to evaluate the usefulness of LUS in comparison with CXR for diagnosing pneumonia in 60 children presented with fever and respiratory distress. For each patient complete diagnostic workup was performed including history, physical examination, routine laboratory investigations, CXR and LUS. LUS was performed by a sonographer blinded to patient’s clinical and CXR findings. The patients were classified into; Pneumonia group: included 45 patients diagnosed by two clinicians as having community acquired pneumonia (CAP) based on the recommendations of British Thoracic Society and Non pneumonia group: included 15 patients received other diagnoses. The clinicians were blinded to CXR and LUS findings. In pneumonia group, sonographic and radiographic findings compatible with pneumonia were found in 95.6% and 88.9% of patients respectively. In non pneumonia group, LUS can exclude pneumonia in 93.3% of patients while CXR excluded pneumonia in 86.7% of them. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of LUS to demonstrate lung involvement were higher than those of CXR (95.6%, 93.3%, 97.7%, 85.7% and 94.5% versus 88.9%, 86.7%, 95.2%, 72.2% and 86.7% respectively). LUS was superior to CXR in identifying pleural effusion and multiple consolidation in more than one lobe. Being safer, cheaper and relatively more time saving, lung ultrasonography offers an important contribution to the diagnosis of CAP in febrile children with respiratory distress compared to chest X-ray.
Lung Ultrasonography, Chest X-ray, Pneumonia, Community Acquired Pneumonia, Respiratory Distress
To cite this article
Rania Salah El Zayat, Wael Abbass Bahbah, Waleed Abd Elfattah Mousa, Lung Ultrasonography Versus Chest X Ray for Diagnosing Pneumonia in Children with Fever and Respiratory Distress: A Prospective Blind Study, American Journal of Pediatrics. Vol. 4, No. 1, 2018, pp. 15-20. doi: 10.11648/j.ajp.20180401.14
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WHO Organization. Pneumonia. 2016. Available from:; Accessed 12 August 2017.
Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health Organization. 2008;86(5):408-16.
World Health Organization: World Health Statistics 2014. Available from:; Accessed 11 July 2017.
Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011;66(2):1-23.
Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clinical infectious diseases. 2011;53(7):25-76.
Bowen S-JM, Thomson AH. British Thoracic Society Paediatric Pneumonia Audit: a review of 3 years of data. Thorax. 2013;68(7):682-3.
Davies HD, Wang EE, Manson D, Babyn P, Shuckett B. Reliability of the chest radiograph in the diagnosis of lower respiratory infections in young children. The Pediatric infectious disease journal. 1996;15(7):600-4.
Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. New England Journal of Medicine. 2007;357(22):2277-84.
Chotas HG, Ravin CE. Chest radiography: estimated lung volume and projected area obscured by the heart, mediastinum, and diaphragm. Radiology. 1994;193(2):403-4.
Hayden GE, Wrenn KW. Chest radiograph vs. computed tomography scan in the evaluation for pneumonia. The Journal of emergency medicine. 2009;36(3):266-70.
Syrjälä H, Broas M, Suramo I, Ojala A, Lähde S. High-resolution computed tomography for the diagnosis of community-acquired pneumonia. Clinical Infectious Diseases. 1998;27(2):358-63.
Pereda MA, Chavez MA, Hooper-Miele CC, Gilman RH, Steinhoff MC, Ellington LE, et al. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics. 2015;135(4):714-22.
Thukral BB. Problems and preferences in pediatric imaging. The Indian journal of radiology & imaging. 2015;25(4):359.
World Health Organization Pneumonia Vaccine Trial Investigators Group, Standardization of Interpretation of Chest Radiographs for the Diagnosis of Pneumonia in Children, WHO document WHO/V&B/0135, 2001, pp. 1-32. Available at:; Accessed 8 July 2017.
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive care medicine. 2012;38(4):577-91.
Copetti R, Cattarossi L. Ultrasound diagnosis of pneumonia in children. La radiologia medica. 2008;113(2):190-8.
Lichtenstein DA, Lascols N, Mezière G, Gepner A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive care medicine. 2004;30(2):276-81.
Reissig A, Kroegel C. Sonographic diagnosis and follow-up of pneumonia: a prospective study. Respiration. 2007;74(5):537-47.
Riccabona M. Ultrasound of the chest in children (mediastinum excluded). European radiology. 2008;18(2):390-9.
Fleiss J, Levin B, Paik M. Statistical methods for rates and proportions, 3rded. Hoboken, NJ: John Wiley & Sons Inc; 2013.
Urbankowska E, Krenke K, Drobczyński Ł, Korczyński P, Urbankowski T, Krawiec M, et al. Lung ultrasound in the diagnosis and monitoring of community acquired pneumonia in children. Respiratory medicine. 2015;109(9):1207-12.
Samson F, Gorostiza I, González A, Landa M, Ruiz L, Grau M. Prospective evaluation of clinical lung ultrasonography in the diagnosis of community-acquired pneumonia in a pediatric emergency department. European Journal of Emergency Medicine. 2018;25(1):65-70.
Ticinesi A1, Lauretani F, Nouvenne A, Mori G, Chiussi G, Maggio M, et al. Lung ultrasound and chest x-ray for detecting pneumonia in an acute geriatric ward. Medicine (Baltimore). 2016;95(27):4153.
Ye X, Xiao H, Chen B, Zhang S. Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Adult Community-Acquired Pneumonia: Review of the Literature and Meta-Analysis. PLoS ONE. 2015;10(6):0130066.
Eibenberger KL, Dock WI, Ammann ME, Dorffner R, Hörmann M, Grabenwöger F. Quantification of pleural effusions: sonography versus radiography. Radiology. 1994;191(3):681-4.
Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. The Journal of the American Society of Anesthesiologists. 2004;100(1):9-15.
Kurian J, Levin TL, Han BK, Taragin BH, Weinstein S. Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. American Journal of Roentgenology. 2009;193(6):1648-54.
Sartori S, Tombesi P. Emerging roles for transthoracic ultrasonography in pulmonary diseases. World journal of radiology. 2010;2(6):203.
Esposito S, Papa SS, Borzani I, Pinzani R, Giannitto C, Consonni D, et al. Performance of lung ultrasonography in children with community-acquired pneumonia. Italian journal of pediatrics. 2014;40(1):37.
Chavez MA, Naithani N, Gilman RH, Tielsch JM, Khatry S, Ellington LE, et al. Agreement between the World Health Organization algorithm and lung consolidation identified using point-of-care ultrasound for the diagnosis of childhood pneumonia by general practitioners. Lung. 2015;193(4):531-8.
Jones BP, Tay ET, Elikashvili I, Sanders JE, Paul AZ, Nelson BP, Spina LA, et al. Feasibility and Safety of Substituting Lung Ultrasonography for Chest Radiography When Diagnosing Pneumonia in Children. Chest. 2016; 150(1):131-138.
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