Is chest sonography a breakthrough in diagnosis of pulmonary thromboembolism in children?

Objective: Sonographic criteria of pulmonary thromboembolism (PTE) have been already evaluated basing on adult patients. There are limited studies to determine diagnostic value of chest ultrasound (CUS) in pediatric PTE. The aim of our study was to present usefulness of ultrasound examination of chest in diagnosis of PTE in children.

Material And Methods: We present results of chest ultrasound examinations of six children: three teenagers--13-year-old boy treated for primary antyphospholipid syndrome, 14-year-old boy with Wegeners' granuloma, and 15-year-old girl with urosepsis--where sonographic results were compared to CT results, and three newborns with congenital heart disease--two boys treated for hypoplastic left heart syndrome (HLHS) and one for duct-dependent coarctation of the aorta (CoA, PDA). Because of severe clinical condition of the newborns, other imaging tests could not be performed. Ultrasound examination was performed as bedside emergency examination using GE Logic 500 with linear probe 8.2-11.0 MHz.

Results: In all cases suggestion of PTE was based on ultrasound examination. Sonograms showed: bilateral, peripheral, subpleural, hypoechoic, triangular and oval lesions, accompanied by pleural effusion. In all three teenagers the diagnosis of PTE was confirmed by CT.

Conclusions: Bedside chest ultrasound examination is especially useful in children with high risk of PTE and in critical general condition. In newborns in severe general condition ultrasound examination of chest should be first imaging test for PTE. It is significant to set on a multicenter study to evaluate the diagnostic value of chest ultrasound in diagnosis of PTE in children.