GP clinic lung consolidation diagnosis

This is a case from last week – 21month old boy, one week of cough, had seen another practioner 4 days prior, started on amoxycillin/clavulinic acid, persistent fevers, up all night coughing, drinking, not eating.  Child looked unwell. T38.5, HR140, RR40, Sp02RA 93%, slight rib retraction, warm peripheries, well hydrated, nil rash. Red TM, flat tonsils, crepitations right lung base. GPPOCUS with linear probe, lung 6 region, this is region 2 on the right:

2yearShredEffusion
(guardian consent obtained for image and case use)

Demonstrating shred (breaking up of the visceral pleural line), effusion and increased density in the lung (hepatisation – the lung looks like liver in terms of echogenicity).

These are the lung zones:

LungPOCUSzonesLichenstein
Lichenstein CHEST / 134 / 1 / JULY, 2008

They went to the local ED with mother and chest radiograph confirmed right peri-hilar consolidation. POCUS did not definitely change my management here – Sp02 was low, there was persistent fever and they looked unwell.  However knowing there was right dependent lung consolidation confirmed that I wasn’t sentencing the family to an ED wait in vain.  I called family today and after a change of oral antibiotics the fever is down, eating better and more interactive.

Useful references:

Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008;134:117–25.

Varshney T, et al. Point-of-care lung ultrasound in young children with
respiratory tract infections and wheeze Emerg Med J 2016;0:1–8.

 

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Author: gppocus

Urban general practioner in Melbourne, Australia

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