ED Lung Ultrasound of Suspected Atelectasis and Assessment of Reaeration in Children

Objectives: Point-of-care ultrasound of the lung is a useful tool in the assessment of pediatric patients with acute respiratory distress or hypoxemia. However, the sonographic features of atelectasis and pneumonia appear similar. Unlike pneumonia, the use of lung ultrasound to diagnose atelectasis and assess its reaeration in children is not well described. We describe the lung ultrasound features of atelectasis correlated with radiographic imaging and clinical context. Methods: This series describes 5 pediatric ED patients with atelectasis, confirmed by lung ultrasound with radiographic correlation, to illustrate the use of PoCUS in guiding interventions such as chest physiotherapy and assessing reaeration. Results: In all 5 cases, lung ultrasound identified lung consolidations consistent with atelectasis, which appeared sonographically similar to pneumonia. Static air bronchograms were seen in all cases. In 1 case of asthma exacerbation, repeat ultrasound demonstrated complete resolution of atelectasis following chest physiotherapy, correlating with clinical improvement. In the other 4 cases, including patients with cystic fibrosis and bronchiolitis, the consolidations persisted on repeat ultrasound despite various treatments for atelectasis. Conclusions: The overlap between the sonographic features of lung consolidation in atelectasis and pneumonia in children makes it difficult to distinguish between the 2 conditions reliably based on lung ultrasound alone. Clinicians will need to interpret PoCUS images within the patient’s clinical context, using radiographic correlation when available. Assessment of atelectasis reaeration on lung ultrasound is feasible and easily repeatable at the point of care, allowing for real-time monitoring of lung consolidations in response to therapy.