Pulmonary ultrasonography in the follow-up of respiratory distress syndrome on preterm newborns. Reduction of X-ray exposure.

PURPOSE: Respiratory distress syndrome (RDS) is the most common cause of respiratory failure in preterm neonates, whose lungs are often immature. The diagnosis and follow-up are based on clinical and radiographic findings. Due to the problem of air artifacts, ultrasonography (US) is not used routinely in the diagnosis of lung diseases. However, when the alveolar air content decreases, as it does in RDS, characteristic patterns appear that can be observed during US lung examinations. The aim of this study was to determine whether the use of chest radiographs in neonates with RDS could be reduced by the routine use of chest US for follow-up examinations. MATERIALS AND METHODS: From April through September 2008, were enrolled all preterm newborns, with very low birth weight (VLBW), consecutive admitted in NICU with clinically and radiologically diagnosed RDS. We performed lung ultrasound examination in this patients. Video-taped US examinations were done every 8-12 h until clinical resolution of the disease was observed. Chest X-rays were performed only in unclear cases. We compared the number of chest radiographs obtained in the NICU during this period and during the preceding six months. RESULTS: 105 serial US lung examinations were performed in 21 preterm infant with clinically and radiologically diagnosed RDS. US lung examinations revealed "comet-tail" artifacts that were compact, diffuse, and symmetrically distributed throughout both lung fields. In 8 cases, the pleural line was also extensively thickened and irregular, and in 7 cases multiple subpleural hypoechoic areas indicative of lung consolidation were observed (mainly on posterior and lateral scans). The mean number of chest radiographs per infant performed in the NICU during the study period was significantly lower than that of the preceding six months (2.6 ± 1 versus 3.8 ± 1.5; p < 0.05). CONCLUSIONS: Chest ultrasound is a valid alternative for the follow-up of VLBW infants with RDS, which can decrease the need for chest X-rays and reduce patient exposure to ionizing radiation.

[Echographic findings in a case of gastric leiomyoblastoma]. / Rilievi ecografici su un caso di leiomioblastoma gastrico.

Gastric leiomyoblastoma is a rare stomach tumour arising in the muscular tunica. Its prevalently oesophytic development makes diagnostic techniques that mainly concentrate on the intestinal lumen (digestive X-ray and endoscopy) of little use. A case is reported in which echography pointed diagnosis in the right direction by analysing a number of typical symptomatological signs.

[Hemobilia. The echographic findings in a dialyzed patient]. / Emobilia. Rilevamento ecografico in un paziente dializzato.

A case of gall bladder haematoma observed echographically in a dialysed patient is reported. The observation was probably related to the administration of anticoagulants during dialysis.

[Echographic study in evaluating gastrointestinal pathology]. / L'indagine ecografica nella valutazione della patologia del tratto gastrointestinale.

The echographic study of the gastrointestinal tract is hampered by the presence of gas that prevents the long-range penetration of the ultrasound beam. However the presence of a mass with a central echogenic region surrounded by a sonolucent wall of over 1.5 cm is characteristic of intestinal pathologies. A study of 23 patients with gastrointestinal disorders in whom echography revealed specific pictures is presented.

[Echography in prenatal diagnosis of chorioangioma of the placenta]. / L'ecografia nella diagnosi prenatale del corionangioma della placenta.

Ultrasound during pregnancy is a valid method to determine foetal growth. Occasionally abnormalities are detected. We report a case in which an echographic study showed a placental chorioangioma. We underline ultrasound patterns and examine clinical features.

[Echotomography in polycystic renal disease]. / Ecotomografia allargata nella malattia policistica renale.

Sonography is a safe and suitable diagnostic tool; to date it appears to be the most valuable method for detecting renal cystic lesions. In particular ultrasound examination, if a wider district is screened, can demonstrate the coexistence of the cystic disease in different organs. The Authors report a case of renal polycyctic disease in which the sonographic examination was extended to the entire abdomen disclosing simultaneous involvement of the kidneys and the liver.