Comparative study of lung ultrasound patterns of clinically diagnosed severe pneumonia and acute chest syndrome among pediatric sickle cell anemia patients at Mulago Hospital

Abstract

Background: Acute chest syndrome (ACS) and severe pneumonia are both common potentially lethal conditions among sickle cell anemia (SCA) pediatric patients. However, both conditions are clinically and radiographically indistinguishable which results in delayed patient diagnosis and management. In this study we compared Lung ultrasound (LUS) patterns among admitted pediatric SCA patients clinically diagnosed with ACS and severe pneumonia at Mulago Hospital. Methods: This was a comparative cross-sectional study and enrolled 178 admitted SCA pediatric patients below 18 years clinically diagnosed with ACS and severe pneumonia. The study was conducted at ward 16 A Mulago Hospital, Uganda between November 2023 to April 2024. Patient clinical assessment, chest x-ray and LUS were done for all children within 24 hrs of admission. Imaging findings on LUS among the two clinical groups were compared and so were CXR findings. Bivariate and multivariate analysis was done using a modified Poisson model and prevalence ratios at 95% confidence intervals were reported. Results: All the 178 enrolled children had complete data available for analysis. Overall, (71.4%), were clinically diagnosed with ACS while (28.6%), had severe pneumonia. LUS features among children with clinically diagnosed with ACS included; normal findings (3.1%), mild basal bilateral anechoic pleural effusion (1.6%), pleural thickening (39.4%), diffuse B lines (80.3%), pleural irregularity (88.2%), and subcentimeter consolidations (22.0%). LUS features among admitted pediatric SCA patients clinically diagnosed with severe pneumonia included; mixed pattern (70.6%), consolidation (76.5%), pleural thickening (31.4%), mild to moderate echogenic bilateral basal pleural effusion (37.3%), diffuse B lines (90.2), and pleural irregularity (92.0%). Conclusion: Lung ultrasound can be considered an add on tool to physical examination in evaluation of pediatric SCA patients with a normal chest radiograph who are clinically diagnosed with severe pneumonia or ACS.