Recommendations for Lung Ultrasound in Internal Medicine

A growing amount of evidence prompts us to update the first version of recommendations for lung ultrasound in internal medicine (POLLUS-IM) that was published in 2018. The recommendations were established in several stages, consisting of: literature review, assessment of literature data quality (with the application of QUADAS, QUADAS-2 and GRADE criteria) and expert evaluation carried out consistently with the modified Delphi method (three rounds of on-line discussions, followed by a secret ballot by the panel of experts after each completed discussion). Publications to be analyzed were selected from the following databases: Pubmed, Medline, OVID, and Embase. New reports published as of October 2019 were added to the existing POLLUS-IM database used for the original publication of 2018. Altogether, 528 publications were systematically reviewed, including 253 new reports published between September 2017 and October 2019. The new recommendations concern the following conditions and issues: pneumonia, heart failure, monitoring dialyzed patients' hydration status, assessment of pleural effusion, pulmonary embolism and diaphragm function assessment. POLLUS-IM 2020 recommendations were established primarily for clinicians who utilize lung ultrasound in their everyday clinical work.

Lung Ultrasonography in the Evaluation of Interstitial Lung Disease in Systemic Connective Tissue Diseases: Criteria and Severity of Pulmonary Fibrosis - Analysis of 52 Patients.

OBJECTIVES: Patients with a diagnosed systemic connective tissue disease require regular monitoring from the point of view of interstitial lung disease. The main aim of this work is a description of the criteria for pulmonary fibrosis and the degree of the severity of the fibrosis during the course of interstitial lung disease through the TLU (transthoracic lung ultrasound). MATERIALS AND METHODS: 52 patients with diagnosed diffuse interstitial lung disease were qualified for this research, together with 50 volunteers in the control group. The patients in both groups were over 18 years of age and were of both sexes. The results of the TLU of the patients underwent statistical analysis and were compared to High-Resolution Computed Tomography (HRCT) results. RESULTS: As a consequence of the statistical analysis, we defined our own criteria for pulmonary fibrosis in TLU: irregularity of the pleura line, tightening of the pleura line, the fragmentary nature of the pleura line, blurring of the pleura line, thickening of the pleura line, artifacts of line B ≤ 3 and ≥ 4, artifacts of Am line and subpleural consolidations < 5 mm. As a result of the conducted research, a scale of severity of pulmonary fibrosis in TLU was devised (UFI - Ultrasound Fibrosis Index), enabling a division to be made into mild, moderate and severe cases. CONCLUSIONS: Transthoracic Lung Ultrasonography (TLU) gives a new outlook on the diagnostic possibilities, non-invasive and devoid of ionising radiation, of pulmonary fibrosis. This research work has allowed to discover two new ultrasound symptoms of pulmonary fibrosis (blurred pleural line and Am lines).

Intravenous application of second-generation ultrasound contrast agents in children: a review of the literature.

CEUS examinations using second-generation ultrasound contrast agents (UCA) are conducted in children, despite not being registered for individuals less than 18 years of age. We searched the Medline® database through Pubmed® and Scopus database, in order to find articles in which UCA were administered intravenously in patients under the age of 18. We analyzed in detail 9 papers (7 case reports, 2 original research studies), describing the examinations with intravenous administration of the UCA in children, and 23 original papers, in which the study group included at least one individual under the age of 18. Neither of the analyzed studies included any reports of adverse effects after UCA administration.

Gastric outlet obstruction due to an iatrogenic cause in a neonatal period - report of two cases.

Gastric mucosa hyperplasia is a rare cause of upper gastrointestinal obstruction in the neonatal period. One of the etiologic factors of this disorder is prolonged prostaglandin E1 (PGE1) therapy of neonates with congenital cyanotic heart diseases. Continuous PGE1 administration ensures patency of the ductus arteriosus, which is essential for stabilizing the general condition until cardiac surgery can be performed. The clinical symptoms of gastric mucosa foveolar hyperplasia due to long-term PGE1 therapy simulate hypertrophic pyloric stenosis. However, the characteristic ultrasound appearance of both pathologies facilitates determination of the final diagnosis and further treatment. We present two cases of neonates with gastric mucosa and submucosa hyperplasia revealed during ultrasound examination. The results of the ultrasound examination combined with clinical anamnesis allowed diagnosis of gastric mucosa foveolar hyperplasia due to prolonged PGE1 therapy.

[Efficacy and safety of renal biopsy in children performed with an automatic biopsy device under control of ultrasonographic imaging]. / Skutecznosc i bezpieczenstwo biopsji nerki u dzieci wykonanej aparatem automatycznym pod kontrola obrazu ultrasonograficznego.

UNLABELLED: The efficacy and safety of kidney biopsy in children performed with an automatic Biopty Gun device under real time ultrasound was analysed. The procedure was performed under sedation during short hospitalisation with ultrasound assessment of complications performed after 24 hours. 98% of 131 biopsies yielded representative material with an average 16 glomeruli obtained per biopsy. Symptomatic perirenal haematomas were observed in 80%, subcapsular haematomas in 3.8% and arteriovenous fistulas in 4.6% of children on post biopsy ultrasound. They resolved spontaneously in all patients. CONCLUSIONS: Real time ultrasound guidance with the use of automatic biopsy devices should become the standard practice for kidney biopsy in children due to its efficacy and safety. The procedure should be performed during short hospitalization to enable ultrasound monitoring of early complications.

[Bilateral hydrothorax in a 13-year old girl treated with continuous ambulatory peritoneal dialysis renal replacement therapy]. / Obustronny przezprzeponowy przeciek plynu dializacyjnego do jam oplucnowych u 13-letniej dziewczynki leczonej nerkozastepczo metoda ciaglej cyklicznej dializy otrzewnowej.

Bilateral hydrothorax is a very rare complication of ambulatory peritoneal dialysis in children. We present a case of a 13-year-old girl who developed bilateral acute hydrothorax during after seven months of CCPD. Peritoneal dialysis was temporarily discontinued and the child was transferred to haemodialysis. Six weeks later the patient was successfully resumed CCPD.

[Bilateral renal obstruction caused by cystine stones in a child with Henoch-Schönlein syndrome]. / Przypadek dziewczynki z zespolem Schönleina-Henocha i ostra zanerkowa niewydolnoscia nerek z powodu kamicy cystynowej.

Haematuria is a typical symptom of glomerular involvement in Henoch-Schoenlein syndrome in children. The authors present an unusual case of haematuria and deterioration of renal function caused by cystine stones in a child with anaphylactic purpura. This 6 year old girl was hospitalized because of severe gastrointestinal symptoms in the course of a typical Henoch-Schoenlein syndrome. After 4 weeks of illness--the child demonstrated haematuria and oliguria with severe loin pain and a rise in serum creatinine to 5.8 mg%. Urine findings of mainly non-glomerular erythrocytes and slight proteinuria were suggestive of a non-glomerular cause of renal failure. Ultrasound examination revealed the unexpected finding of bilateral kidney obstruction caused by multiple renal stones. Cystine crystals observed under microscopic examination of the urinary sediment and a positive cyanide-nitroprusside test suggested cystinuria as the cause of nephrolithiasis. High water intake and alkalization of urine and captopril for cystine excretion reduction resulted in fast improvement of renal function and and with time complete dissolution of calculi. The symptoms of Henoch-Schoenlein syndrome resolved over several weeks, and the child did not develop any signs of glomerular involvement.

[Ultrasound of exit-site and tunnel infections in children on peritoneal dialysis]. / Ocena ultrasonograficzna zapalenia ujscia i kanalu cewnika Tenckhoffa u dzieci dializowanych otrzewnowo.

Ultrasound diagnosis of catheter related infections in patients on peritoneal dialysis is easy to perform diagnostic procedure which enables more precise diagnosis and better follow-up of therapy. The authors present three cases of exit site and tunnel infections in children, illustrating the value of ultrasound evaluation in their diagnosis and in decisions on conservative treatment or catheter removal.

[Clinical manifestation of toxic pancreas lesion in children with hematopoietic malignancies]. / Obraz kliniczny toksycznego uszkodzenia trzustki u dzieci ze schorzeniami rozrostowymi ukladu krwiotwórczego.

From January 1994 until May 1997, 54 children with leukemia and non Hodgkin lymphoma were analyzed. The enzymatic function and ultrasound examination of pancreas were estimated. In 17 of 54 patients the clinical symptoms suggesting pancreatitis or toxic lesion of pancreas were observed. In 13 cases L-asparaginase was administered. The main symptom of the pancreas disease was severe abdominal pain with vomiting. The typical ultrasound view of pancreatitis was observed in 4 cases, pancreas oedema was seen in 6 patients. The most serious course of pancreatitis was diagnosed in 3 children. Diabetes mellitus coexisted in two cases, in the third case osteoporosis was seen. Because of the toxic pancreas lesion in one patient the administration of L-asparaginase and cortical hormones was discontinued, in the remaining 2 children the therapeutic scheme was modified. In all 17 cases this side effect was completely reversible, as well as in 3 children with the most serious clinical course of pancreas lesions.

[The clinical course of fungal urinary tract infection in neonates]. / Grzybica ukladu moczowego noworodków--obserwacje wlasne.

The authors present the clinical course of 8 cases of fungal infection of the urinary tract in newborns. Three of the investigated children were premature or with intrauterine hypotrophy, a congenital defect of the urinary tract was detected in one child. In 5 cases the fungal infection followed bacterial septicaemia. Two of the 8 children required peritoneal dialysis, another two required insertion of intravenous catheters for parenteral feeding, and four required bladder catheterisation. The diagnosis of fungal urinary tract infection was established on the basis of urine culture, the presence of specific serum anti-candida antibodies and results of ultrasonographic examination (vs). In 7 of 8 cases the possibility of fungal infection was suggested by US examination. Seven children were treated with fluconazole combined with 5-fluorocytosine, one was treated with fluconazole. Pyelostomy was performed, in two of the patients all of them received supportive treatment. Our clinical observations point to the necessity of prophylaxis in case of predisposing factors to fungal infection and the use of abdominal ultrasonography for detection of early stages of fungal urinary tract infection.

Epidemiologic estimation of goiter in children from Gdansk, Elblag, Olsztyn and Torun districts (Gdansk coordinating center).

The study comprised 1604 children (49.9% of boys and 50.1% of girls) of age between 6 and 13 years living in the districts of Gdansk, Elblag, Olsztyn and Torun. 55.5% of children were from urban area, 44.5% from rural area. This districts have been divided into 3 geographic regions. 1) Olsztyn region: 174 children and the villages near Olsztyn--178 children, 2) Seaside region: Gdansk and Elblag--358 children and 3 villages situated in the distance less than 60 km from the sea--533 children, 3) Torun region: Torun--181 children and villages near Torun--180 children. A significant relationship between the incidence of goiter and the place of living was found. The presence of goiter was observed in 9.2% of children in Gdansk and Elblag and in 23% of children in the seaside region (with the peak in Glincz village--35%). In Olsztyn region the incidence was 18.2%, in Torun region--12.5%. Among 1604 studied subjects in 263 (16.4%) with goiter, the nodular goiter was in 2.3% of cases. The lowest occurrence of goiter was noted in Gdansk and Elblag. Urinary iodine concentration in children with goiter from Gdansk and Elblag (123.1 micrograms/l) was higher than in those living in villages in the seaside region (90.8 micrograms/l). The thyroid size as measured by ultrasonography was different in children with and without goiter in each age group. In the age group of 6-8 years it was 4.8 ml in children without goiter and 6.3 ml in children with goiter, in the age group 9-10 years, 5.7 ml and 8.6 ml, in the age group 11-12 years, 6.6 ml and 10.0 ml, in children 13 years old--8.0 ml and 12.1 ml. All the children with goiter have greater body weight and height than those in the same age groups without goiter. 13.2% of studied persons consumed iodized salt. There was no difference in the incidence of goiter in children receiving and not receiving iodized salt (13.4% and 13.1% in all regions). There was also lack of relation between urinary iodine concentration and rate of consumption of iodized salt.