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Japanese

Title 臨床に役立つ小児呼吸器超音波検査
Subtitle 特集 小児呼吸器疾患に対する放射線診断のトピックス
Authors 星野雄介1), 富所由佳2,3), 河野達夫3), 竹井寛和4)
Authors (kana)
Organization 1)茨城県立こども病院 新生児科, 2)東京都立大塚病院 小児科, 3)東京都立小児総合医療センター 放射線科, 4)兵庫県立こども病院 救急科
Journal 日本小児放射線学会雑誌
Volume 39
Number 2
Page 75-89
Year/Month 2023 /
Article 報告
Publisher 日本小児放射線学会
Abstract 「要旨」呼吸器超音波検査(US)の所見は(1)A line(多重反射アーチファクト:胸膜と平行な線状高輝度), (2)B line(小水滴によるacoustic trap:胸膜から深部に伸びる線状高輝度), (3)lung sliding(呼吸に合わせ胸膜ラインがスライドする)に代表される. 気管挿管確認のUSは精度が高く, 動的snowstorm sign/bullet sign, 食道への誤挿管double tract signを参考にする. 気胸のUSは広く普及し, lung slidingの消失, B lineの消失, lung pointの存在等を総合診断する. 胸水検出能は高く, 胸腔内の無エコー域として(膿胸は相対的高輝度域として)描出される. 肺実質は壁側胸膜直下は直接観察可能で, 肺炎, 化膿症, 腫瘍, 奇形が診断可能である. B lineなどの間接所見により, 細気管支炎や肺水腫の診断にも有用とされる. 新生児一過性多呼吸では肺胞液の吸収遅延がB lineとして観察され, 呼吸の改善とともに所見も改善する. 呼吸窮迫症候群は, 軽症ではA lineとB lineの混在, 重症ではA lineは認めずwhite lungパターンを呈し, サーファクタント投与の判断にも活用できる.
Practice 臨床医学:一般
Keywords 肺超音波, 肺スライディング, ポイントオブケア, コウモリ徴候, 新生児, Lung ultrasound, Lung sliding, Point of care, Bat sign, Newborn

English

Title Pediatric ultrasound of the respiratory tract : Clinical applications
Subtitle [Special Feature] The topics of radiological diagnosis in pediatric respiratory disease
Authors Yusuke Hoshino1), Yuka Tomidokoro2,3), Tatsuo Kono3), Hirokazu Takei4)
Authors (kana)
Organization 1)Department of Neonatology, Ibaraki Children's Hospital, 2)Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, 3)Department of Radiology, Tokyo Metropolitan Children's Medical Center, 4)Department of Pediatric Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital
Journal Journal of Japanese Society of Pediatric Radiology
Volume 39
Number 2
Page 75-89
Year/Month 2023 /
Article Report
Publisher Japanese Society of Pediatric Radiology
Abstract [Abstract] Ultrasound for the respiratory tract has been considered useful in various settings of pediatric practice. Important findings include A lines (linear high-echogenicity lines parallel to the pleura), B lines (lines perpendicular to the pleura), and lung sliding (movement of the pleural line in synchrony with breathing). Appropriate tracheal intubation is confirmed using the snowstorm/bullet signs and the absence of the double tract sign. Pneumothorax is characterized by the disappearance of lung sliding and B lines, and the presence of a lung point. Even a small amount of pleural fluid is also detectable. Effusion presents as anechoic fluid in the pleural cavity, while in contrast, empyema has higher echogenicity. Ultrasound further allows for direct observation of pulmonary parenchyma adjacent to the parietal pleura, enabling detection of conditions such as pneumonia, abscess, tumors, and malformations. Indirect findings such as B lines may also be helpful for the diagnosis of bronchiolitis and pulmonary edema. In transient tachypnea of the newborn, delayed absorption of lung fluid is demonstrated as the presence of B lines. In respiratory distress syndrome, an admixture of A lines and B lines is found in mild cases and a white lung pattern without A lines is found in severe cases. These observations can be applied to determination of the need for surfactant administration.
Practice Clinical medicine
Keywords Lung ultrasound, Lung sliding, Point of care, Bat sign, Newborn
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