Pediatric lung ultrasound: reply to Corsini et al.
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LETTER TO THE EDITOR
Pediatric lung ultrasound: reply to Corsini et al. Jovan Lovrenski 1 Received: 6 August 2020 / Revised: 6 August 2020 / Accepted: 13 August 2020 / Published online: 9 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editors, In reply to Corsini et al. [1], it is hard to find a greater fan and admirer of lung ultrasound than me. Therefore, I definitely do not see any hint of discouragement in my article. On the contrary, in both my recent articles [2, 3], I tried to balance the radiologist’s and clinician’s perception of lung ultrasound, pointing out very important issues, such as mutual understanding, the importance of realizing the limits of both the diagnostic procedure and the ability to interpret it, the role of experience, and the need to establish proper training and teaching guidelines. &
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I am glad transient tachypnea of the newborn was mentioned. All of us working in neonatal intensive care units know that we still need further studies to confirm signs that currently stand as pathognomonic, whether it is double lung point sign or altered pleural line [4]. However, when we try to distinguish respiratory distress syndrome from transient tachypnoea, we need to keep this in mind: There are different stages of respiratory distress syndrome and the stage has a strong impact on the lung ultrasound features. I agree that diagnosis of pneumothorax is extremely important and highly accurate —- in experienced hands. Unfortunately, clinicians often do not acknowledge the importance of practice and experience. Both my own experience from 2008 onward and the experience of my residents later on show that it is not easy to confidently diagnose pneumothorax in the beginning. That is why inexperienced sonographers need to take one step at a time [3]. Also, signs of pneumothorax can sometimes point to
* Jovan Lovrenski [email protected] 1
Faculty of Medicine, Radiology Department, Institute for Children and Adolescents Health Care of Vojvodina, University of Novi Sad, Hajduk Veljkova 3, Novi Sad 21000, Serbia
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other pathological entities, which is very important to mention. I was very precise when writing about the time consumption of a lung ultrasound exam, cost-benefit ratio, and reasons why clinicians, especially neonatologists, should “take over” this examination to a certain extent. I do not understand how this is different from the position of Corsini et al. [1]. Misinterpretation will not bring neonatologists and radiologists closer.
Even in their conclusion, Corsini et al. [1] mostly rephrase the opinions set out in my article. However, I am not so sure that clinicians should perform lung ultrasound in older children. I am not even sure that most clinicians would agree with such a proposal. Maybe it should be determined by each children’s hospital’s organizational structure. At my hospital, for example, pediatric pulmonologists do not have the time to perform lung ultrasound. Also, somehow it seems a bit unfair to push only the complex, hard-to-
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