Diagnostic ultrasound ( PDFDrive )

1710 PART V Pediatric Sonography
A
B
FIG. 50.14 Color Flow Doppler Signal in Pleural Fluid With Debris. (A) Gray-scale sonogram shows left pleural luid with much debris.
(B) Color low Doppler signal.
Fluid
Heart
Lung
A
B
FIG. 50.15 Bilateral Pleural Fluid and Pericardial Fluid in Critically Ill Patient. (A) Chest radiograph of infant receiving extracorporeal
membrane oxygenation (ECMO) shows complete lung opaciication. (B) Transverse sonogram shows pleural luid around both collapsed lungs and
a small amount of pericardial luid.
distinguishing thick pleural luid from solid masses. Consolidated
lung supericial to aerated lung will have increased through
transmission compared with the aerated lung and can be identiied
as lung parenchyma by the presence of air or luid bronchograms.
Collapsed or consolidated lung tissue oten has the appearance
of the liver or spleen. A patient with persistent pleural luid not
responding to drainage can be evaluated by ultrasound for a
possible underlying tumor (Fig. 50.17).
Another pitfall in the sonographic evaluation of the chest is
the acoustic shadow cast by a rib (rib shadowing), which may
confuse the inexperienced sonographer into misinterpreting that
a mass is anechoic. he transducer should be placed between
the ribs to avoid this pitfall. he echogenicity of the mass or
pleural lesion can be compared with that of the liver.
Parapneumonic Collections and Empyema
Parapneumonic collections occur in up to 40% of children with
bacterial pneumonia and are especially common in those younger
than 4 years. 10 Most collections are not infected, but many evolve
into empyemas with frank pus. Parapneumonic efusions detected
by ultrasound can be prognostic in children with pneumonia.
Children with complicated collections characterized by septations