Silvana Caiulo

Lung Ultrasound Characteristics of Community-Acquired Pneumonia in Hospitalized Children

The diagnosis of community‐acquired pneumonia (CAP) is based mainly on the patients medical history and physical examination. However, in severe cases a further evaluation including chest X‐ray (CXR) may be necessary. At present, lung ultrasound (LUS) is not included in the diagnostic work‐up of pneumonia.

Lung ultrasound in bronchiolitis: comparison with chest X-ray

The diagnosis of bronchiolitis is based mainly on the patient’s medical history and physical examination. However, in severe cases, a further evaluation including chest X-ray (CXR) may be necessary. At present, lung ultrasound (LUS) is not included in the diagnostic work-up of bronchiolitis. This study aimed to compare the diagnostic accuracy of LUS and CXR in children with bronchiolitis, and to evaluate the correlation between clinical and ultrasound findings. Only patients with a diagnosis of bronchiolitis, who had undergone a CXR, were enrolled in the study. Fifty-two infants underwent LUS and CXR. LUS was also performed in 52 infants without clinical signs of bronchiolitis. LUS was positive for the diagnosis of bronchiolitis in 47/52 patients, whereas CXR was positive in 38/52. All patients with normal LUS examination had a normal CXR, whereas nine patients with normal CXR had abnormal LUS. In these patients, the clinical course was consistent with bronchiolitis. We found that LUS is a simple and reliable tool for the diagnosis and follow-up of bronchiolitis. It is more reliable than CXR, can be easily repeated at the patient’s bedside, and carries no risk of irradiation. In some patients with bronchiolitis, LUS is able to identify lung abnormalities not revealed by CXR. Furthermore, there is a good correlation between clinical and ultrasound findings. Given the short time needed to get a US report, this technique could become the routine imaging modality for patients with bronchiolitis.

Mild TSH resistance: clinical and hormonal features in childhood and adulthood

Mutations in TSH receptor (TSHR) are associated with TSH resistance, a genetic defect characterized by a heterogeneous phenotype ranging from severe hypothyroidism to subclinical hypothyroidism (SCH). We assessed the clinical and hormonal pattern of TSHR variants in a series of pediatric patients, and the long‐term outcome of growth, biochemical measurements of metabolism, and neuropsychological functions in TSHR mutations carriers.

Rare cases of autoimmune hypothyroidism in young children

Abstract Acquired autoimmune hypothyroidism is common in late childhood and adolescence but is very rare in the first 3 years of life. We report on three cases of autoimmune thyroiditis (AT) in young children who presented with constipation, decreased appetite, and increased hours of sleep. Our cases highlight that AT may remain undiagnosed for a long time in young children owing to the rarity of the disease.

72nd Congress of the Italian Society of Pediatrics

Child and youth migrations are a particularly dramatic and a daily aspect of the more general problem of contemporary migration flows. Behind and within each of the stories of these children accompanied and unaccompanied migrant children, as UN calls them in a bureaucratic jargon school becomes a treasure trove of identity splinters through biographies and fragments of a past that can return visibility to what would be irreparably forgotten otherwise. School has the opportunity to welcome, support, accompany these children and young new citizens towards the inclusion. School has, also, the opportunity to learn an anthropological view of the presence of migrant children from these life stories, thus activating action-research processes. This action-research will develop new teaching strategies, new approaches based on questions, on an open dialogue, on the paradigms of responsibility, commitment and diversity. A unique opportunity to develop diversity education and citizenship skills, too often mentioned but poorly practiced. Above all, thanks to the sharing and revival of significant life stories and emotionally touching, you can develop emotional intelligence skills, so necessary in an often deregulated age of complexity, which always produces more and more “wasted lives”, above all, thanks to the sharing and reintroduction of significant and emotionally touching life stories. Through a generous listening of students’ lives, and dialogic practices, school could generate new narrations of migration processes, thus replacing those narrations made up of stereotypical clichés, believes, petty and selfish believes of an overlapping lawlessness, of cruelty and hypocritical welcome. These new narrations tell of possibilities, of mutual discoveries, of processes of successful inclusion, of present-future to build together. “The dialogical as Arnkil and Seikkula say is not a method or a set of techniques but it is an attitude, a way of seeing, which is based on recognizing and respecting the otherness of the other, and on going to meet them.” Applying the integrated dialogic approach to coaching as a lifestyle means to mobilize psychological resources of both people who are directly involved and the whole community and local social network, it means being able to stimulate dialogue. Stories of wanderings and landings, escapes and refuges, of scared identities and unpredictable cultural metamorphosis, of so much suffering, are intertwined and interdependent to the dreamed and

Transient Neonatal Hypothyroidism

Transient neonatal hypothyroidism is defined as a temporary abnormality of the thyroid function discovered at birth, which later reverts to a normal status. It may or may not require replacement therapy. Recovery to euthyroidism typically occurs in the first few months or years of life.

Response to lung ultrasound as an additional imaging tool for the evaluation of pneumonia.

We thank Dr. Catalano for his interest in our paper. The letter raises several interesting issues deserving clarification. Catalano argues that our observation and conclusion in lung ultrasound (LUS) characteristics of communityacquired pneumonia (CAP) differ from a similar study published by Shah et al. In our study, LUS examinations were performed by an expert pediatric sonographer. The study by Shah was conducted by 15 pediatric emergency physicians. They underwent a 1-hr chest sonography training session given before the start of the study. Furthermore our data relate to 89 inpatients, who had been admitted to a Pediatric Department with diagnosis of pneumonia, whereas Shah studied 200 patients seen

Nephrogenic remnants: occasional ultrasound diagnosis and follow-up

Nephrogenic remnants (NRs) are nodular collections of undifferentiated renal blastema cells in the postnatal kidney that are recognized as putative precursor lesions of Wilms tumor (WT). NRs may remain stationary, undergo regression, or proliferate. In the last case, there is a high risk for the development of a WT. During infancy, they are most frequently of microscopic size, to be found only at autopsy in approximately 1% of infant kidneys. Approximately 1 out of 100 microscopic lesions persist and grow developing lesions large enough to be seen by ultrasound in the first months of life. We report on a case of NRs in a six year old child, as incidental finding during abdominal ultrasound performed for other purposes. In consideration of the potential evolution in WT, after a period of close surveillance of 14 months, the lesion was resected. Histological examination revealed the presence of NRs, no neoplastic lesions were found. Currently the patient is 16 years old, in good health, and there have been no signs of recurrence.

Sensitivity and feasibility of lung ultrasound in bronchiolitis—reply to the correspondence letter by Catalano

We thank Dr Catalano et al. for their interest on our article. The comment raises two important issues, one regarding the test sensitivity and the second, more general, on test feasibility. Assuming the final diagnosis as a gold standard, lung ultrasound (LUS) showed an excellent sensitivity (47/52 vs 38/52 of chest x-ray, 90 vs 73 %), but we have to consider the observational characteristics of the study design, performed in a real-world setting with real patients, real problems, and real doctors, with clinically driven indication to chest xrays. This is typical of an observational effectiveness study; it is not an efficacy study, evaluating the technique under ideal conditions, and the observed results can be more directly relevant to clinical practice but also vulnerable to selection bias [1]. The authors raise concerns about the equipment setting and rationale for chest x-ray prescription. We reported this information in the Methods section: chest x-ray was always requested by the attending physician on the basis of the clinical picture; the equipment used for the lung ultrasound was a Toshiba Nemio machine, equipped with a high-resolution linear probe with frequencies ranging from 6 to 12 MHz. Regarding the second issue on the practical appeal of the method, we reported our gratifying experience in the demanding theater of a neonatal intensive care unit, consistent with the international consensus that the method is simple, safe, and sensitive—when challenged under controlled conditions versus appropriate gold standards [5]. Dr Catalano argues that lung ultrasound relying on artifacts, such as B-lines, is not an evidence-based best-practice imaging clue. We agree with that: LUS is not always able to provide a detailed anatomical definition, especially when we consider B-lines. However, we believe that the usefulness of LUS relies in being an additional imaging tool for the evaluation of the lung, which is quick, bedside, low-cost, non-ionizing, and very sensitive to detect the loss of air content. Of course, LUS should be integrated with other imaging modalities, when a detailed anatomical definition is needed. It is also true that every new diagnostic tool always raises many uncertainties when it is proposed. Given the high versatility and potential clinical implications of adding ultrasound to the regular imaging equipment, we believe it is of importance to deepen the knowledge of this technique to better understand its strengths and limitations. Cardiologists who experienced lung ultrasound as an adjunct to much more technically demanding echocardiography say that “from a technical viewpoint, in the echocardiographic cursus studiorum where 2D echo represents the elementary school, Doppler echo the secondary school, and stress echo University, B-lines correspond to kindergarten [3].” We also concur with Daniel Lichtenstein, who recently stated (Montecarlo Lung Ultrasound School 2013) that it takes 20 s to make a lung scan with V. A. Caiulo (*) School of Ultrasound of Italian Federation of Pediatricians, Piazza Angeli 3, 72100 Brindisi, Italy e-mail: antoniocaiulo@inwind.it

Reply to the correspondence letter by P. Toma: usefulness of ultrasound findings in bronchiolitis

abnormalities during the course of the disease. In all cases, clinical improvement was associated with the disappearance of lung ultrasound findings. Lung ultrasound has certainly many limitations and many aspects still need to be clarified. Given the high versatility of the technique and the very promising data obtained in some pathological conditions, we believe it is of importance to describe the lung ultrasound patterns of specific disease, even when, as in bronchiolitis, the diagnosis is mainly based on the clinical signs and symptoms.