Lung ultrasound as useful tool to diagnose pulmonary atelectasis in children affected by neuromuscular disease

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Introduction: Neuromuscular diseases are characterized by weakness of voluntary muscles which determines accumulation of secretions and atelectasis. As a consequence, an excess use of imaging exams is common. It is necessary to identify a reproducible, low cost and reliable diagnostic method to avoid the need for multiple imaging exams. Material and Methods: Pediatric patients affected by neuromuscular diseases admitted to our Unit were enrolled. In patients who underwent a chest X-ray for clinical reasons, a pulmonary ultrasound (PU) was also performed. Results: X-ray and PU were performed in 27 patients (mean age: 7.5 years). PU highlighted pulmonary atelectasis in 13/27 cases. In 2 patients PU was not conclusive because of severe scoliosis. Out of the 12 patients with negative PU for atelectasis, in two patients PU described pulmonary thickening, in one of those cases complicated by pleural effusion. X-ray described 13/27 cases positive for atelectasis and, between the negative, 1 patient with pneumonia. Considering X-ray as the gold standard, concordance between the two examinations showed: Sensitivity 100%, Specificity 85,7%; Negative predictive value 100%, Positive predictive value: 86,6%. Moreover, it is important to point out that in 2 cases with atelectasis, the PU also allowed to detect a pleural effusion, not described by X-ray. Conclusions: Our results show that PU has an excellent diagnostic reliability in identifying pulmonary atelectasis in children with neuromuscular diseases. PU could be a useful test in the follow-up and diagnosis of pulmonary atelectasis, allowing a significant reduction in ionizing radiation for young and fragile patients.

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