Improving Pulmonary Edema Assessment in Pediatric Congenital Heart Disease: The Role of Lung Ultrasonography.

BACKGROUND

Pulmonary edema is a clinically significant complication in children with congenital heart disease (CHD). It occurs more frequently in complex cases and is associated with prolonged hospital stays. Early identification is essential because of its direct impact on clinical outcomes.

OBJECTIVES

To evaluate lung ultrasonography (LUS) as a diagnostic tool for pulmonary edema and to identify associated clinical and laboratory factors in children with CHD.

METHODS

Children with CHD who underwent LUS between September 2020 and September 2023 were included. LUS findings were compared with clinical data, chest radiography results, and B-type natriuretic peptide (BNP) levels. Patients were classified according to pathophysiological category (pulmonary overflow, pulmonary hypertension, or other).

RESULTS

A total of 62 children were evaluated, with a median age of 5.5 months (interquartile range, 4-10.1 months). Pulmonary overflow was identified in 49 patients (79%), pulmonary hypertension in seven (11.3%), and other pathophysiological conditions in six (9.7%). The median BNP level was 815.5 pg/mL. Pulmonary edema was detected in 36 patients (58%) by chest radiography and in 33 patients (53%) by LUS. A significant overlap was observed, as 79% of patients with positive LUS findings also demonstrated edema on chest radiography (p < 0.001). In contrast, only 34.5% of patients with negative LUS findings had radiographic evidence of edema. Pulmonary edema was significantly associated with recurrent lower respiratory tract infections, underweight status, body mass index below -2 standard deviations, and increased BNP levels. Multivariate logistic regression analysis identified failure to thrive as an independent predictor of pulmonary edema. Chest radiography findings remained the primary factor associated with pulmonary edema.

CONCLUSION

LUS is a reliable, radiation-free modality for detecting pulmonary edema in children with CHD. Identification of associated risk factors may facilitate early recognition of vulnerable patients and support timely, appropriate clinical interventions.