EC Pulmonology and Respiratory Medicine

Research Article Volume 13 Issue 10 - 2024

Comparative Study of Lung Ultrasound Patterns of Clinically Diagnosed Severe Pneumonia and Acute Chest Syndrome among Pediatric Sickle Cell Anemia Patients at Mulago Hospital

Julius Kimera1*, Deogratias Munube2, Faith Ameda1 and Geoffrey Erem1,3

1Assistant Professor (Former), Laboratory of Lung Inflammation, Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama, United States

2Department of Pediatrics, Mulago National Referral Hospital, Kampala, Uganda

3Department of Radiology, St Francis Hospital, Nsambya

*Corresponding Author: Julius Kimera, Department of Radiology, College of Health Sciences, Makerere University, Kampala, Uganda.
Received: August 02, 2024; Published: October 04, 2024



Background: Acute chest syndrome (ACS) and severe pneumonia are both common potentially lethal conditions among sickle cell anemia (SCA) pediatric patients. However, both conditions are clinically and radiographically indistinguishable which results in delayed patient diagnosis and management. In this study we compared Lung ultrasound (LUS) patterns among admitted pediatric SCA patients clinically diagnosed with ACS and severe pneumonia at Mulago Hospital.

Methods: This was a comparative cross-sectional study and enrolled 178 admitted SCA pediatric patients below 18 years clinically diagnosed with ACS and severe pneumonia. The study was conducted at ward 16 A Mulago Hospital, Uganda between November 2023 to April 2024. Patient clinical assessment, chest x-ray and LUS were done for all children within 24 hrs of admission. Imaging findings on LUS among the two clinical groups were compared and so were CXR findings. Bivariate and multivariate analysis was done using a modified Poisson model and prevalence ratios at 95% confidence intervals were reported.

Results: All the 178 enrolled children had complete data available for analysis. Overall, (71.4%), were clinically diagnosed with ACS while (28.6%), had severe pneumonia. LUS features among children with clinically diagnosed with ACS included; normal findings (3.1%), mild basal bilateral anechoic pleural effusion (1.6%), pleural thickening (39.4%), diffuse B lines (80.3%), pleural irregularity (88.2%), and subcentimeter consolidations (22.0%). LUS features among admitted pediatric SCA patients clinically diagnosed with severe pneumonia included; mixed pattern (70.6%), consolidation (76.5%), pleural thickening (31.4%), mild to moderate echogenic bilateral basal pleural effusion (37.3%), diffuse B lines (90.2), and pleural irregularity (92.0%).

Conclusion: Lung ultrasound can be considered an add on tool to physical examination in evaluation of pediatric SCA patients with a normal chest radiograph who are clinically diagnosed with severe pneumonia or ACS.

 Keywords: Clinically Diagnosed Acute Chest Syndrome; Clinically Diagnosed Severe Pneumonia; Lung Ultrasound; Pediatrics; Sickle Cell Anemia

  1. Rees D., et al. “Sickle-cell disease”. Lancet 9757 (2010): 2018-2031.
  2. Ndeezi G., et al. “Burden of sickle cell trait and disease in the Uganda Sickle Surveillance Study (US3): a cross-sectional study”. The Lancet Global Health 3 (2016): e195-e200.
  3. Vichinsky E., et al. “Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group”. New England Journal of Medicine 25 (2000): 1855-1865.
  4. Battersby, A., et al. “Susceptibility to invasive bacterial infections in children with sickle cell disease”. Pediatric Blood and Cancer 3 (2010): 401-406.
  5. Howard J., et al. “Guideline on the management of acute chest syndrome in sickle cell disease”. British Journal of Haematology 4 (2015): 492-505.
  6. Cohen SG., et al. “Utility of point-of-care lung ultrasonography for evaluating acute chest syndrome in young patients with sickle cell disease”. Annals of Emergency Medicine 3S (2020): S46-S55.
  7. Jain S., et al. “Acute chest syndrome in children with sickle cell disease”. Pediatric Allergy, Immunology, and Pulmonology 4 (2017): 191-201.
  8. Paintsil V., et al. "Development of multi-level standards of care recommendations for sickle cell disease: experience from sickle in Africa". Frontiers in Genetics 13 (2023): 1052179.
  9. “Integrated management of childhood illnesses: chart booklet”. Geneva: World Health Organization (2014).
  10. Samsygina GA. “Infektsii resspiratornogo trakta u detey rannego vozrasta (respiratory infections in young children)”. Moscow: Pul’s M (2013): 260.
  11. Preto-Zamperlini M., et al. “Point-of-care lung ultrasound is more reliable than chest X-ray for ruling out acute chest syndrome in sickle cell pediatric patients: A prospective study”. Pediatric Blood and Cancer 5 (2022): e29283.
  12. Platt O., et al. “Mortality in sickle cell disease-life expectancy and risk factors for early death”. New England Journal of Medicine 23 (1994): 1639-1644.
  13. Gladwin M., et al. “Divergent nitric oxide bioavailability in men and women with sickle cell disease”. Circulation2 (2003): 271-278.
  14. Kyomuhangi A., et al. “Diagnostic performance of chest ultrasound in diagnosing pneumonia in pediatric patients at Mulago national referral hospital, Kampala, Uganda”. EC Pulmonology and Respiratory Medicine2 (2023): 03-16.
  15. Styles L., et al. “Refining the value of secretory phospholipase A2 as a predictor of acute chest syndrome in sickle cell disease: results of a feasibility study (PROACTIVE)”. British Journal of Haematology 5 (2012): 627-636.
  16. Iuri D., et al. “Evaluation of the lung in children with suspected pneumonia: usefulness of ultrasonography”. La Radiologia Medica2 (2009): 321-330.
  17. Prina E., et al. “Lung ultrasound in the evaluation of pleural effusion”. Jornal Brasileiro de Pneumologia: Publicacao Oficial da Sociedade Brasileira de Pneumologia e Tisilogia 1 (2014): 1-5.
  18. Shah S., et al. “Lack of predictive value of tachypnea in the diagnosis of pneumonia in children”. The Pediatric Infectious Disease Journal 5 (2010): 406-409.
  19. Pardue J., et al. “Feasibility and safety of substituting lung ultrasonography for chest radiography when diagnosing pneumonia in children. A randomized controlled trial”. Chest1 (2016): 131-150.
  20. Milner BHA., et al. “Lung consolidation locations for optimal lung ultrasound scanning in diagnosing pediatric pneumonia”. Journal of Ultrasound in Medicine 11 (2017): 2325-2328.
  21. Razazi K., et al. “Bedside lung ultrasound during acute chest syndrome in sickle cell disease”. Medicine (Baltimore) 7 (2016): e2553.
  22. Stadler JAM., et al. “Lung ultrasound for the diagnosis of community-acquired pneumonia in children”. Pediatric Radiology11 (2017): 1412-1419.
  23. Lichtenstein DA., et al. “Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE Protocol”. Chest 1 (2008): 117-125.
  24. Céline D., et al. “Late Breaking Abstract - Usefulness of lung ultrasound in the diagnosis and early detection of acute chest syndrome in children with sickle cell disease”. European Respiratory Journal65 (2021): PA3547.
  25. Calder A., et al. “Imaging of parapneumonic pleural effusions and empyema in children”. Pediatric Radiology 6 (2009): 527-537.
  26. Heuvelings CC., et al. “Chest ultrasound for the diagnosis of pediatric pulmonary diseases: a systematic review and meta-analysis of diagnostic test accuracy”. British Medical Bulletin 1 (2018): 35-51.
  27. Claes AS., et al. “Performance of chest ultrasound in pediatric pneumonia”. European Journal of Radiology 88 (2017): 82-87.

Julius Kimera., et al. "Comparative Study of Lung Ultrasound Patterns of Clinically Diagnosed Severe Pneumonia and Acute Chest Syndrome among Pediatric Sickle Cell Anemia Patients at Mulago Hospital". EC Pulmonology and Respiratory Medicine  13.10 (2024): 01-14.

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