AUTHOR=Carrard Johann , Bacher Sebastien , Rochat-Guignard Isabelle , Knebel Jean-François , Alamo Leonor , Meuwly Jean-Yves , Tenisch Estelle 

TITLE=Necrotizing pneumonia in children: Chest computed tomography vs. lung ultrasound

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.898402

DOI=10.3389/fped.2022.898402

ISSN=2296-2360

ABSTRACT=Background 
The utiliation of contrast-enhanced computed tomography of the chest (CT) for the diagnosis of necrotizing pneumonia (NP), a complication of community-acquired pneumonia, is controversial because of the inherent ionizing radiation involved. Over the last few years, the growing availability of bedside Lung Ultrasound (LUS) devices has led to increased use of this non-ionizing imaging method for diagnosing thoracic pathology, including pneumonia.

Objective 
The objectives of the present study were: first, to compare the performance of LUS vs CT in the identification of certain radiologic signs of NP and second, to determine whether LUS could replace CT in the diagnosis of NP.

Materials and Methods 
We compared retrospectively the CT and LUS images of 41 patients between 2005 and 2018 in whom at least one contrast injected chest CT scan and one LUS had been undertaken fewer than 7 days apart.

Results 
Pleural effusions were demonstrated almost systematically (100% on CT vs 95.8% on LUS). Visualization of septations in pleural effusions was clearly superior on LUS (20.4% on CT vs 62.5% on LUS). Concerning the detection of necrosis, we observed a strong correlation between LUS and the gold standard CT (95.8% on LUS vs 93.7% on CT). Parenchymal cavities were more easily detected on CT than on LUS (79.1% vs 35.4%).

Conclusion
LUS has shown to be as effective as CT in the diagnosis of NP. The use of CT in patients with NP could be limited to the detection of complications such as bronchopleural fistulae in unfavorably evolving diseases.