Definitions and diagnostic implications of terms used in the chest radiograph and lung ultrasound diagnoses of pneumonia.

Transcription

1 Supplementary 1 Definitions and diagnostic implications of terms used in the chest radiograph and lung ultrasound diagnoses of pneumonia. Imaging finding Definition Implication CR Consolidation Interstitial infiltrates Pleural effusion Indeterminate Summary of WHO classification(33) Dense, fluffy opacity within a portion, lobe or entire lung. Often containing air bronchograms. Linear and patchy densities in a lacy pattern with peribronchial thickening and multiple areas of atelectasis. Lung inflation normal to increased. Fluid in the pleural space between the lung and chest wall. Usually at costo-phrenic angle or adjacent to lateral chest wall. Does not include fluid in the horizontal or oblique fissures. Term used to describe findings when radiologist s report does not clearly relate to above definitions. Pneumonia (WHO end-point consolidation) Pneumonia a (WHO non-end-point infiltrate) Pneumonia Indeterminate for pneumonia LUS Definition Implication A-lines Hyperechoic horizontal lines at repeated intervals below and parallel to the pleural line.(12) Normal lung (when lung sliding present) b-line Consolidation Air bronchogram Pleural line abnormalities Pleural effusion Hyperechoic vertical line that extends from the pleura (not from consolidation) and reaches the bottom of the screen without fading. May be single (b-line), multiple (Bline pattern) or confluent.(25, 35) The number of b-lines required for a positive finding has not been evaluated in children. Hypoechoic, anechoic or tissue-like region that extends from the pleura with associated pleural line loss or attenuation.(35, 39) Hyperechoic branching lines or oval echoes. Present only within an area of consolidation or atelectasis.(12) Hyperechoic irregularities (thickening or fragmentation) of the pleural line.(10, 25) Anechoic line between parietal and visceral pleura. Moves with respiration.(12, 35) Interstitial syndrome (35) More commonly associated with viral respiratory infections including bronchiolitis, less commonly pulmonary oedema.(36, 40) Pneumonia or atelectasis (35) Pneumonia or atelectasis (12, 39) Non-specific for pneumonia. (35) May represent small subpleural consolidations Non-specific for pneumonia (35) a WHO diagnostic protocol modified for the clinical setting to consider non-end point consolidation as a positive finding.(14, 28) This approach attempts to compensate for the high specificity and poor sensitivity of a tool designed for use in epidemiological research. CR chest radiograph; LUS lung ultrasound

2 Supplementary 2. Examples of A-lines, b-lines, confluent B-lines and pleural line abnormalities on lung ultrasound.

3 Supplementary 3. Examples of lung consolidations, air bronchograms and pleural effusions on lung ultrasound

4 Supplementary 4. Lung ultrasound and chest radiograph results for patients with possible pneumonia, n=97 CR+ CR ind. a CR Total LUS LUS Total LUS >1cm LUS b Total a Indeterminate CRs grouped with negative CR for tests of accuracy to avoid favouring LUS results b Positive LUS 1cm grouped with negative LUS for tests of accuracy(27) CR chest radiograph; LUS lung ultrasound; ind. indeterminate

5 Supplementary 5. Diagnostic result of each lung ultrasound a Results for first half of study combine the first half of patients scanned by each sonologist, n=48 sens. sensitivity; spec. specificity; CR chest radiograph; LUS lung ultrasound

6 Supplementary 6. Example of a patient with a positive chest radiograph and a negative lung ultrasound

7 Supplementary 8. Example of a patient with a negative chest radiograph and a positive lung ultrasound

8 Sonographic consolidation Supplementary 10. Data for Figure 2. Lung ultrasound result with subgroups by clinical/chest radiograph diagnosis of pneumonia and antibiotic treatment, n=97 Number of patients treated with antibiotics Number of patients not treated with antibiotics Pneumo/LRTI Other resp. a Other b Pneumo/LRTI Other resp. a Other b Total Positive >1cm Positive 1cm Negative Total a Other respiratory included: bronchiolitis, asthma, wheeze, viral respiratory infection, respiratory distress, upper respiratory tract infection, cough b Other condition included: viral infection, febrile illness, other disorders of ear, otitis media, meningitis, urosepsis, abdominal pain, chest pain LRTI lower respiratory tract infection; Pneumo pneumonia; resp. - respiratory