Purpose: There is no publication on the possibility of the use of transthoracic lung ultrasound (TLU) in the diagnosis of invasive pulmonary aspergillosis (IPA) in children. The diagnosis IPA and the decision to start systemic antifungal therapy is mainly based on clinical criteria and diagnostic imaging of the lungs using high resolution computed tomography (HRCT).
Aim of study: The aim of the study was to investigate the role of TLU in the diagnosis of IPA in children with neoplastic disease of the hematopoietic system.
Methods: From November 2009 to June 2012 an initial diagnosis of IPA was done 30 times in a group of 26 children (12 girls and 14 boys, mean age 12.7 years) on the basis of TLU. In the analyzed group of patients, the diagnosis of IPA was confirmed by other diagnostic methods and clinical course. Sonographic criteria for the diagnosis of IPA was established on the basis of criteria for the diagnosis of bacterial pneumonia including the two typical features of fungal inflammation such as angioinvasion and destruction of tissue in the affected area. We analyzed the results of ultrasound examination comparing them to the results of computed tomography.
Results: In the analyzed group of patients TLU sensitivity in the diagnosis of IPA was estimated at 100%, specificity 73.3% and the positive predictive value (PPV) of 65.6% and negative predictive value (NPV) of 100%, with CT as the reference method. Analysis of clinical course and treatment of IPA in the context of the initial diagnosis posed by TLU it should be noted that compliance in this group of patients was 100%.
Conclusions: Analysis of ultrasound image changes in the lungs of children with clinically documented diagnosis of IPA confirms that the diagnosis of IPA using transthoracic lung ultrasound is possible.
