Lung ultrasound

Thanks to Daniela Villegas Martinez for the filming of the performance of the live lung ultrasound! A special thanks to Dr Maria Fraga from Children's Hospital of Philadelphia (co-PI of the PuRPOSE Study) for reviewing the content and providing guidance for the preparation, orchestration and content review. Thanks to Florence and her family for accepting to be part of the filming!

Neonatal Lung Ultrasound Presentation

Lung US JAN 2021.pdf

Presentation prepared by Dr Punnanee Wutthigate during her Neonatal Hemodynamics Clinical Research Fellowship at McGill University.

Basic review of lung ultrasound slides

Lung-US.pdf

Video recording available on top.

Clinical Applications of Lung Ultrasound by Dr Lauren Ruoss

Crashing Neonate POCUS pre-conference material by Dr Lauren Ruoss

Lung Ultrasound Score

Scoring system from: "Brat, R., Yousef, N., Klifa, R., Reynaud, S., Aguilera, S. S., & De Luca, D. (2015). Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA pediatrics, 169(8), e151797-e151797."

We use a linear probe (hockey-stick) at the NeoCardioLab and obtain 3-5 seconds clip in the:

Right upper lobe (RUL): above the mamillary line;
Right lower lobe (RLL): below mamillary line and sliding up to the liver edge;
Right lateral lobe (RLatL): starting at the mid-axillary line under the axilla and sliding to the diaphragmatic liver edge;
Left upper lobe (LUL);
Left lower lobe (LLL): we sometimes have to slide the probe in an area that is not filled by cardiac structures;
Left lateral lobe (LLatL: sliding up to the diaphragmatic to gastric/splenic area).

Score 0

Score 1

Score2

Score 3

Lung ultrasound demonstrating the lung-liver interface and diaphragm (liver on the right hand side of the image)

Another example of a Score 3 (consolidation)

Examples of Coalescent B-Lines in a premature infant with BPD

Another score is the one proposed here.

Zong H, Huang Z, Zhao J, Lin B, Fu Y, Lin Y, Huang P, Sun H, Yang C. The Value of Lung Ultrasound Score in Neonatology. Front Pediatr. 2022 May 11;10:791664. doi: 10.3389/fped.2022.791664. PMID: 35633958; PMCID: PMC9130655.

fped-10-791664.pdf

Pneumothorax

Lung ultrasound demonstrating a pneumothorax on the left side

M-Mode applied on the LUS with pneumothorax on the left side demonstrating a barcode (stratosphere) sign

Lung ultrasound demonstrating severe B-lines (coalescent B-lines) without consolidation - Score 2.

M-Mode applied on the LUS on the contralateral (right) lung demonstrating absence of a pneumothorax. We can see the motion artefacts from the high frequency oscillation on the M-Mode. This image corresponds to the "sand on the beach" sign (absence of a pneumothorax)

Orientation of the linear probe on the chest of the newborn

Position of the linear probe or Butterfly-IQ+ probe for the lung ultrasound. Cursor of the probe towards the head of the baby (cranial orientation). RUL (Right upper lobe), LUL (left upper lobe), RLL (right lower lobe), LLL (left lower lobe), RLatL (right lateral lobe), LLatL (left lateral lobe).

Pleural Effusions

Module on effusions can be found on this part of the website.

Bilateral pleural effusions in the subxyphoid view.

Pleural effusion seen with a sweep in a RV-focused apical view

Bilateral pleural effusions in the subxyphoid view.

Selection of video modules available on Youtube

Other resources

Other great resources regarding neonatal lung ultrasound can be found on this NICUPocus webpage.

Lung Ultrasound Made Easy