July 2022 - Erik Küng

Dr. Erik Küng

MedUni Wien RESEARCHER OF THE MONTH July 2022

Lung ultrasound is fast, cheap, readily available, well tolerated and can be learned quickly. Up until now there is no typical sign in lung ultrasound for pneumomediastinum in neonates. We report the case of a neonate delivered by caesarean section with respiratory distress. Laboratory investigations found normal parameters of infection. A lung ultrasound showed no signs of respiratory distress syndrome, transient tachypnoea of the newborn or pneumothorax. However, in the parasternal view, a stairway-like set of horizontal hyperechogenic reflections was seen instead of the great arteries indicating the presence of trapped air below the thymus. A chest X-ray confirmed the diagnosis of a pneumomediastinum.

In conclusion, stairway-like arranged hyperechogenic lines below the thymus, the "Stairway Sign", are a distinct sign for pneumomediastinum in neonates. Recently we were able to reproduce this sign in two other neonates with pneumomediastinum and never in neonates without pneumomediastinum.

Selected Literature

1. Küng, E., Habrina, L., Berger, A., Werther, T., Aichhorn, L., Diagnosing pneumomediastinum in a neonate using a lung ultrasound. Lancet, 4;398(10303):e13 (2012). https://doi.org/10.1016/S0140-6736(21)01592-0
2. Lichtenstein, D. A., Mauriat ,P. Lung ultrasound in the critically ill neonate. Current Pediatric Reviews 8(3), 217-223 (2012). https://doi.org/ 10.2174/157339612802139389
3. Küng, E., Aichhorn, L., Berger, A., & Werther, T. Mirrored Ribs: A Sign for Pneumothorax in Neonates. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 21(10), e944–e947 (2020). https://doi.org/10.1097/PCC.0000000000002381
4. Küng, E., Habrina, L., Schneider, M., Werther, T., Aichhorn, L. Neonatologie: Lungenultraschall Standard. Zenodo (2021). https://doi.org/10.5281/zenodo.3968810
5. Aichhorn, L., Küng, E., Habrina, L., Werther, T., Berger, A., Urlesberger, B., Schwaberger, B. The Role of Lung Ultrasound in the Management of the Critically Ill Neonate-A Narrative Review and Practical Guide. Children 8, 628 (2021). doi:10.3390/children8080628
6. Liu, J., Copetti, R., Sorantin, E., Lovrenski, J., Rodriguez-Fanjul, J., Kurepa, D., Feng, X., Cattaross, L., Zhang, H., Hwang, M., Yeh, T. F., Lipener, Y., Lodha, A., Wang, J. Q., Cao, H. Y., Hu, C. B., Lyu, G. R., Qiu, X. R., Jia, L. Q., Wang, X. M., Ren X. L., Guo J. Y., Gao Y. Q., Li J. J., Liu Y., Fu, W., Wang. Y., Lu Z. L., Wang H. W., Shang, L. L. Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus. Journal of visualized experiments (145), 10.3791/58990 (2019). https://doi.org/10.3791/58990