Pediatric lung ultrasound: Tips and tricks for better scanning and interpretation

Pediatric lung ultrasound: Tips and tricks for better scanning and interpretation

Authors

  • Anna Maria Musolino Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
  • Laura Gori Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, 56100, Pisa, Italy.
  • Monica Tei Clinical Pediatrics, Department of Mother and Child, Siena University Hospital, Siena, Italy https://orcid.org/0000-0003-1651-7402
  • Maria Chiara Supino Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
  • Carmen D'Amore Epidemiology, Clinical Pathways and Clinical Risk Unit, Medical Direction, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
  • Marta Ciofi degli Atti Epidemiology, Clinical Pathways and Clinical Risk Unit, Medical Direction, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
  • Lorenzo Di Sarno Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, 00168 Rome, Italy.
  • Antonella Amendolea Pediatric Unit, Cecina Civil Hospital, Cecina, Italy.
  • Alessandro Manganaro Pathology and Neonatal and Pediatric Intensive Care Unit, University Hospital G. Martino, Messina, Italy.
  • Gino Soldati Hippocrates Medical Center, Castelnuovo di Garfagnana (Lucca), Italy.
  • Francesco Tursi Cardiopulmonary Rehabilitation Unit, Codogno Hospital, Lodi, Italy.
  • Danilo Buonsenso Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
  • Cristina De Rose Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
  • Renato Cutrera Pediatric Pulmonology and Cystic Fibrosis Unit Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, ERN - Lung Reference Center for Rare Respiratory diseases Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
  • Marco Cirillo Department of Diagnostic Imaging, Radiology Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
  • Paolo Tomà Department of Diagnostic Imaging, Radiology Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
  • Caterina Bock Department of Diagnostic Imaging, Radiology Unit, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
  • Francesco Esposito Department of Emergency Radiology, Santobono-Pausilipon Children Hospital, Naples, Italy.
  • Alberto Villani Department of Emergency, Admission and General Pediatrics, Unit of General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
  • Vincenzo Colacino Health District of Central Friuli, Cividale del Friuli, Italy.
  • Annarita Iadecola NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant’Andrea University Hospital, 00189, Rome, Italy.
  • Paolo Adamoli Multiclinic Advanced Medical Systems, Morbegno (Sondrio), Italy.
  • Gian Luca Trobia Pediatric and Pediatric Emergency Room Unit, Cannizzaro Emergency Hospital, 95126 Catania, Italy.
  • Alfina Domenica Coco Pediatric Unit, Moriggia Pelascini Hospital, Gravedona et Uniti, 22015 Como, Italy.
  • Giuseppe Limoli Department of Pediatrics, Lodi Hospital, 26900 Lodi, Italy.
  • Rino Agostiniani Department of Pediatrics and Neonatology, San Jacopo Hospital, Via Ciliegiole 97, 51100, Pistoia, Italy.
DOI: https://doi.org/10.5826/mrm.2026.1074

Keywords:

pediatric lung ultrasound, chest sonography, children, point-of-care ultrasound

Abstract

In recent decades lung ultrasound (LUS) has emerged as an invaluable bedside imaging tool for the evaluation of respiratory conditions such as pneumonia, bronchiolitis, pneumothorax, and pleural effusion in pediatric age, thanks to the thin chest wall and absence of rib ossification. Despite its growing application, optimizing technique and interpretation remains crucial for reliable diagnostic performance. The present educational paper provides practical tips and tricks to enhance the accuracy, efficiency, and clinical value of LUS in pediatric patients, focusing on probe selection, patient positioning, scanning technique, common artifacts, and interpretation pitfalls.

References

1.Liu L, S. Oza S , D. Hogan D , Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015; 385: 430–40.

2. Coley BD. Chest sonography in children: current indications, techniques, and imaging findings. Radiol Clin North Am 2011; 49: 825–46.

3. Joshi P, Vasishta A, Gupta M. Ultrasound of the pediatric chest. Br J Radiol 2019; 92: 20190058.

4. Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 1997; 156: 1640-6.

5. Soldati G, Iacconi P. The validity of the use of ultrasonography in the diagnosis of spontaneous and traumatic pneumothorax. J Trauma 2001; 51: 423.

6. Musolino AM, Tomà P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, et al. Ten Years of Pediatric Lung Ultrasound: A Narrative Review. Front Physiol 2022; 12: 721951.

7. McDermott C, Daly J, Carley S. Combatting COVID-19: is ultrasound an important piece in the diagnostic puzzle? Emerg Med J 2020; 37: 644-49.

8. Pecho-Silva S, Navarro-Solsol AC, Taype-Rondan A, Torres-Valencia J, Arteaga-Livias K, Herriman DA, et al. Pulmonary Ultrasound in the Diagnosis and Monitoring of Coronavirus Disease (COVID-19): A Systematic Review. Ultrasound Med Biol 2021; 47: 1997-2005.

9. Supino MC, Buonsenso D, Agostiniani R, Gori L, Tipo V, Morello R et al. The lung ultrasound in children with SARS-COV-2 infection: a national multicenter prospective study. Eur J Pediatr 2024; 183: 3397-3405.

10. Jamil SF, Rajendram R. Training pediatric residents in point-of-care ultrasound: An assessment of the needs and barriers to acquire the skill. Int J Pediatr Adolesc Med 2022; 9: 49-55.

11. McGinness A, Lin-Martore M, Addo N, Shaahinfar A. The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey. BMC Med Educ 2022; 22: 7.

12. Musolino AM, Tei M, De Rose C, Buonsenso D, Supino MC, Zampogna S, et al. Pediatric ultrasound practice in Italy: an exploratory survey. Ital J Pediatr 2024; 50: 114.

13. Bobillo-Perez S, Girona-Alarcon M, Rodriguez-Fanjul J, Jordan I, Balaguer Gargallo M. Lung ultrasound in children: What does it give us? Paediatr Respir Rev 2020; 36: 136-41.

14. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38: 577-91.

15. Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, et al. New International Guidelines and Consensus on the Use of Lung Ultrasound. J Ultrasound Med 2023; 42: 309-344.

16. Soldati G, Demi M, Smargiassi A, Inchingolo R, Demi L. The role of ultrasound lung artifacts in the diagnosis of respiratory diseases. Expert Rev Respir Med 2019; 13: 163-72.

17. Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004; 100: 9-15.

18. Harel-Sterling M, Diallo M, Santhirakumaran S, Maxim T, Tessaro M. Emergency Department Resource Use in Pediatric Pneumonia: Point-of-Care Lung Ultrasonography versus Chest Radiography. J Ultrasound Med 2019; 38: 407-14.

19. Amendolea A, Gori L, Adamoli P, Limoli G, Supino MC, Coco AD, et al. Pleuropulmonary Ultrasound in Pediatrics: Proposal of a Reporting Model From the Academy of Thoracic Ultrasound. J Ultrasound Med 2022; 41: 2637-41.

20. Supino MC, Buonsenso D, Scateni S, Scialanga B, Mesturino MA, Bock C, et al. Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: a prospective study. Eur J Pediatr 2019; 178: 623-632.

21. Mongodi S, De Luca D, Colombo A, Stella A, Santangelo E, Corradi F, et al. Quantitative lung ultrasound: technical aspects and clinical applications. Anesthesiology 2021; 134: 949-65.

22. Gori L, Amendolea A, Buonsenso D, Salvadori S, Supino MC, Musolino AM, et al. Prognostic Role of Lung Ultrasound in Children with Bronchiolitis: Multicentric Prospective Study. J Clin Med 2022; 11: 4233.

23. Camporesi A, Morello R, Guzzardella A, Pierucci UM, Izzo F, De Rose C, et al. A combined rapid clinical and lung ultrasound score for predicting bronchiolitis severity. Intensive Care Med Paediatr Neonatal 2023; 1: 14.

24. Soldati G, Smargiassi A, Demi L, Inchingolo R. Artifactual Lung Ultrasonography: It Is a Matter of Traps, Order, and Disorder. Appl Sci 2020; 10: 1570.

25. Biagi C, Pierantoni L, Baldazzi M, Greco L, Dormi A, Dondi A, et al. Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis. BMC Pulm Med 2018; 18: 191.

26. Di Sarno L, Francavilla M, Orlandi A, Morello R, De Rose C, Tagliaferri L, et al. An international standardization to study the clinical use of lung ultrasound to discriminate viral, bacterial and atypical pneumonia in children with community acquired pneumonia. Ital J Pediatr 2025; 51: 269.

27. Chidini G, Raimondi F. Lung ultrasound for the sick child: less harm and more information than a radiograph. Eur J Pediatr 2024; 183: 1079-89.

28. Jaworska J, Komorowska-Piotrowska A, Pomiećko A, Wiśniewski J, Woźniak M, Littwin B, et al. Diagnostics (Basel) 2020; 10: 935.

29. Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, et al. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24: 65.

30. J. Stassen, Bax JJ. How to do lung ultrasound. Eur Heart J Cardiovasc Imaging 2022; 23: 447-49.

31. D'Amato M, Rea G, Carnevale V, Grimaldi MA, Saponara AR, Rosenthal E, et al. Assessment of thoracic ultrasound in complementary diagnosis and in follow up of community-acquired pneumonia (cap). BMC Med Imaging 2017; 17: 52.

32. Stadler JAM, Andronikou S, Zar HJ. Lung ultrasound for the diagnosis of community-acquired pneumonia in children. Pediatr Radiol 2017; 47: 1412-19.

33. Bobillo-Perez S, Girona-Alarcon M, Rodriguez-Fanjul J, Jordan I, Balaguer Gargallo M. Lung ultrasound in children: What does it give us? Paediatr Respir Rev 2020; 36: 136-41.

34. Dietrich CF, Buda N, Ciuca IM, Dong Y, Fang C, Feldkamp A, et al. Lung ultrasound in children, WFUMB review paper (part 2). Med Ultrason 2021; 23: 443-52.

35. Urbankowska E, Krenke K, Drobczyński Ł, Korczyński P, Urbankowski T, Krawiec M, et al. Lung ultrasound in the diagnosis and monitoring of community acquired pneumonia in children. Respir Med 2015; 109: 1207-12.

36. Shao RJ, Du MJ, Xie JT. Use of lung ultrasound for the diagnosis and treatment of pleural effusion. Eur Rev Med Pharmacol Sci 2022; 26: 8771-76.

37. Zanforlini A, Smargiassi A, Perrone T, Inchingolo R, Torri E, Limoli G, at al. Artifacts and Signs in Lung Ultrasound: The Need for a Revised Classification: Part 1: An Accademia di Ecografia Toracica (AdET) Survey: Part 1: An Accademia di Ecografia Toracica (AdET) Survey. J Ultrasound Med 2022; 4: 2907-09.

38. Jaworska J, Buda N, Ciuca IM, Dong Y, Fang C, Feldkamp A, et al. Ultrasound of the pleura in children, WFUMB review paper. Med Ultrason 2021; 23: 339-47.

39. Soldati G, Copetti R. Thoracic ultrasound 2020. Ed. C.G. Edizioni medico scientifiche, Torino ISBN 978-88-7110-421-8.

40. Raimondi F, Rodriguez Fanjul J, Aversa S, Chirico G, Yousef N, De Luca D, et al. Lung Ultrasound for Diagnosing Pneumothorax in the Critically III Neonate. J Pediatr 2016; 175: 74-78.e1.

41. Deng BY, Li N, Wu WS, He XG, Li JF, Huang TL, et al. Use of Neonatal Lung Ultrasound for the Early Detection of Pneumothorax. Am J Perinatol 2020; 37: 907-13.

42. Cattarossi L, Copetti R, Brusa G, Pintaldi S. Lung Ultrasound Diagnostic Accuracy in Neonatal Pneumothorax. Can Respir J 2016; 2016: 6515069.

43. Lichtenstein D, Mezière G, Biderman P, Gepner A. The "lung point": an ultrasound sign specific to pneumothorax. Intensive Care Med 2000; 26: 1434-40.

44. Caiulo VA, Gargani L, Caiulo S, Fisicaro A, Moramarco F, Latini G, et al. Lung ultrasound in bronchiolitis: comparison with chest X- ray. Eur J Pediatr 2011; 170: 1427-33.

45. Basile V, Di Mauro A, Scalini E, Comes P, Lofù I, Mostert M, et al. Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis. BMC Pediatr 2015; 15: 63.

46. Abdel Kader M, Abou Samra MF, Abdel AaI SMS, Shehata N, Khalifa A. The utility of lung ultrasound in evaluation of infants with suspected bronchitis. Egypt J Radiol Nucl Med 2016; 47: 1057-64.

47. Cohen JS, Hughes N, Tat S, Chamberlain JM, Teach SJ, Boniface K. The utility of bedside lung ultrasound findings in bronchiolitis. Pediatr Emerg Care 2017; 33: 97-100.

48. Varshney T, Mok E, Shapiro AJ, Li P, Dubrovsky AS. Point-of-care lung ultrasound in young children with respiratory tract infections and wheeze. Emerg Med J 2016; 33: 603-10.

49. Taveira M, Yousef N, Miatello J, Roy C, Claude C, Boutillier B, et al. Can a simple lung ultrasound score predict length of ventilation for infants with severe acute viral bronchiolitis? Arch Pediatr 2018; 25: 112-17.

50. Zoido Garrote E, García Aparicio C, Camila Torrez Villarroel C, Pedro Vega García A, Muñiz Fontán M, Oulego Erroz I. Usefulness of early lung ultrasound in acute mild-moderate acute bronchiolitis. A pilot study. An Pediatr (Engl Ed) 2019; 90: 10-8.

51. Buonsenso D, Supino MC, Giglioni E, Battaglia M, Mesturino A, Scateni S, et al. Point of care diaphragm ultrasound in infants with bronchiolitis: a prospective study. Pediatric Pulmonology 2018; 53: 778-86.

52. Jaszczolt S, Polewczyk T, Dolega-kozierowska M, Wozniak M, Doniec Z. Comparison of lung ultrasound and chest x-ray findings in children with bronchiolitis. J Ultrason 2018; 18: 193-97.

53. Bueno-Campaña M, Sainz T, Alba M, Del Rosal T, Mendez-Echevarría A, Echevarria R, et al. Lung ultrasound for prediction of respiratory support in infants with acute bronchiolitis: a cohort study. Pediatr Pulmonol 2019; 54: 873-80.

54. Özkaya AK, Yilmaz HL, Kendir ÖT, Gökay SS, Eyüboğlu İ. Lung ultrasound findings and bronchiolitis ultrasound score for predicting hospital admission in children with acute bronchiolitis. Pediatr Emerg Care 2020; 36: e135-42.

55. Ingelse SA, Pisani L, Westdorp MHA, Almakdase M, Schultz MJ, van Woensel JBM, et al. Lung ultrasound scoring in invasive mechanically ventilated children with severe bronchiolitis. Pediatr Pulmonol 2020; 55: 2799-2805.

56. San Sebastian Ruiz N, Rodrìguez Albarràn I, Gorostiza I, Galletebeitia Laka I, Delgado Lejonagoitia C, Samson F. Point -of- care Lung ultrasound in children with bronchiolitis in a pediatric emergency department. Arch Pediatr 2021; 28: 64-8.

57. Di Mauro A, Ammirabile A, Quercia M, Panza R, Capozza M, Manzionna MM, et al. Acute Bronchiolitis: Is there a role for lung ultrasound? Diagnostics (Basel) 2019; 9: 172.

58. Hernández-Villarroel AC, Ruiz-García A, Manzanaro C, Echevarría-Zubero R, Bote-Gascón P, Gonzalez-Bertolin I, et al. Lung Ultrasound: A Useful Prognostic Tool in the Management of Bronchiolitis in the Emergency Department. J Pers Med 2023; 13: 1624.

59. Rodríguez García L, Hierro Delgado E, Oulego Erroz I, Rey Galán C, Mayordomo Colunga J. Clinical–Ultrasound Model to Predict the Clinical Course in Bronchiolitis. Children (Basel) 2024; 11: 987.

60. D'Alessandro M, Bellini T, Bustaffa M, Chianucci B, Ridella F, Franzone D, et al. Lung Ultrasound Score and Bronchiolitis: What can be Predicted in a Single Center Experience. J Intensive Care Med 2025; 40: 1186-92.

61. O'Connor SD, Kulkarni NM, Griffin MO Jr, Baruah D, Sudakoff GS, Tolat PP. Structured reporting in ultrasound. Ultrasound Q 2020; 36: 1-5.

62. Shea LAG, Towbin AJ. The state of structured reporting: the nuance of standardized language. Pediatr Radiol 2019; 49: 500-8.

.

Downloads

Published

20-02-2026

Issue

Vol. 21 (2026)

Section

Technical Notes

License

Copyright (c) 2026 The Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Mattioli 1885 has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.

How to Cite

1.
Musolino AM, Gori L, Tei M, et al. Pediatric lung ultrasound: Tips and tricks for better scanning and interpretation. Multidiscip Respir Med. 2026;21:1074. doi:10.5826/mrm.2026.1074
Crossref
Scopus
Google Scholar
Europe PMC