POCUS #006

Aung Htay (edits by Viet Tran

A 7 yo presents with 20 days of cough and feeling generally unwell. You hear something funny on auscultation of the left lower zone and thought POCUS might help determine next steps...

Recent covid 19 RAT at home was negative.
The child had subjected fever with lethargy last night.
Usually fit and well with no significant past medical history.
 
Normal work of breathing with normal oxygen saturation.
You've ordered an CXR and proceed to POCUS while waiting:

What do you see in Left lower lobe POCUS image?

Non-translobar consolidation called ‘Shred sign’ in anterior part of the lung
Subpleural consolidation in posterior part of the lung

What about this view?

Translobar consolidation called ‘Tissue-like sign’
Airbronchogram
Trace of fluid (small pleural effusion)

And now?

‘A’ lines (horizontal lines parallel to pleural line from reverberating artefacts)
Likely small area of alveolar consolidation (Shred sign) in deeper part of the lung

You've exhausted the views on the left side (its a kid afterall) and move on and compare the right side:

Anything different?

Mostly normal A-lines (horizontal lines parallel to pleural line from reverberating artefacts)

So you think long and hard about all these grey images...

​What is your impression from Lung POCUS and management of this patient?

Left lower lobe consolidation with parapneumonic effusion
Disposition depends on Pneumonia severity index, patient’s logistic including ability to return to the hospital as well as follow up with GP.

Now you get the CXR of your patient:

​Now you wonder if you really need CXR to make clinical decision if you have ability to do Lung POCUS….