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Updated: May 30, 2025
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Lung Ultrasound-A Supplementary Tool for the Diagnosis of Pulmonary Tuberculosis in Children
Vinita Rathi1, Raveena Rawat2, Sumit Kumar1
1University College of Medical Sciences and Guru TEG Bahadur Hospital, Delhi, India.
Insights
Lung ultrasound (LUS) effectively identifies pulmonary tuberculosis (PTB) in children, offering a non-invasive diagnostic tool. This method shows high detection rates for consolidation and nodules, aiding diagnosis in low-resource settings.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Diagnosing pediatric pulmonary tuberculosis (PTB) faces challenges with microbiological sampling.
- Limited research exists on lung ultrasound (LUS) findings in proven pediatric PTB cases.
Purpose of the Study:
- To investigate LUS appearances in children with microbiologically confirmed PTB.
- To evaluate the inter-observer agreement for LUS findings in pediatric PTB.
Main Methods:
- Prospective evaluation of 30 children with proven PTB using LUS and chest radiography (CR).
- LUS performed by a blinded resident (R1); CR interpreted by an experienced radiologist (R2).
- Second interpretation of LUS by R2 after a month to ensure blinding and reduce bias.
Main Results:
- LUS detected consolidation and subpleural nodules (SUN) in 96.7% of children, predominantly in the lower lung zones.
- A miliary pattern was seen on LUS in 33.3% of cases with normal CR.
- Consolidation detection was significantly higher with LUS (83.3%) compared to CR (43.3%).
- High inter-observer agreement was noted for consolidation, pleural effusion, B lines, and miliary nodules.
Conclusions:
- LUS is a valuable, non-invasive, and radiation-free supplementary tool for diagnosing childhood PTB.
- Findings suggest LUS can aid in PTB diagnosis, especially in resource-limited endemic areas.
- The study highlights the utility of LUS in identifying characteristic PTB patterns not always evident on CR.
Background:
There are logistic problems in obtaining adequate microbiological samples for the diagnosis of pulmonary tuberculosis (PTB) in children, globally. Most studies on ultrasound have evaluated mediastinal nodes in children with tuberculosis (TB), but very few studies are available on lung ultrasound (LUS) appearances in proven PTB.
Purpose:
To study the LUS appearances in children with microbiologically proven PTB and to assess the inter-observer agreement.
Materials And Methods:
Thirty children with microbiologically proven PTB, were evaluated prospectively on LUS and chest radiograph (CR) in Radiology department of a tertiary care hospital, from November 2019 to November 2021. CR was interpreted by an experienced Radiologist (R2); LUS was conducted by a Radiology resident (R1), who was blinded to CR findings; and findings were recorded. Archived static images/videos of LUS were interpreted by R2 after a month, to avoid bias; and findings were recorded.
Results:
Composite LUS finding of either consolidation and subpleural nodule (SUN) was detected in 29/30 (96.7%) children with lower zone predominance (70%). Miliary pattern was observed on LUS in 11/30 (33.3%) children, but their CR was normal. Consolidation was detected on LUS in a significantly higher proportion of children (83.3%) than on CR (43.3%). Inter-observer agreement calculated for detection of consolidation and pleural effusion was k = 0.88, for B lines k = 0.79, confluent B lines k = 0.75, miliary nodules k = 0.70 and SUN k = 0.57.
Conclusion:
We conclude that in low-resource endemic areas, LUS by virtue of being non -invasive and not using ionizing radiation, can be a useful supplementary tool in the diagnosis of childhood PTB.
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