title: Doppler images of intra-pulmonary shunt within atelectasis in anesthetized children.
abstract: BACKGROUND
  Doppler images of pulmonary vessels in pulmonary diseases associated with subpleural consolidations have been described. Color Doppler easily identifies such vessels within consolidations while spectral Doppler analysis allows the differentiation between pulmonary and bronchial arteries. Thus, Doppler helps in diagnosing the nature of consolidations. To our knowledge, Doppler analysis of pulmonary vessels within anesthesia-induced atelectasis has never been described before. The aim of this case series is to demonstrate the ability of lung ultrasound to detect the shunting of blood within atelectatic lung areas in anesthetized children.
  
  
  RESULTS
  Three anesthetized and mechanically ventilated children were scanned in the supine position using a high-resolution linear probe of 6-12 MHz. Once subpleural consolidations were detected in the most dependent posterior lung regions, the probe was rotated such that its long axis followed the intercostal space. In this oblique position, color Doppler mapping was performed to detect blood flow within the consolidation. Thereafter, pulsed waved spectral Doppler was applied in the previously identified vessels during a short expiratory pause, which prevented interferences from respiratory motion. Different flow patterns were identified which corresponded to both, pulmonary and bronchial vessels. Finally, a lung recruitment maneuver was performed which leads to the complete resolution of the aforementioned consolidation thereby confirming the pathophysiological entity of anesthesia-induced atelectasis.
  
  
  CONCLUSIONS
  Lung ultrasound is a non-invasive imaging tool that not only enables the diagnosis of anesthesia-induced atelectasis in pediatric patients but also analysis of shunting blood within this consolidation.
authors.affiliation: Department of Anesthesia, Hospital Privado de Comunidad, Córdoba 4545, 7600, Mar Del Plata, Buenos Aires, Argentina. ceacosta77@icloud.com.
authors.forename: Cecilia M
authors.initials: CM
authors.lastname: Acosta
authors.affiliation: Department of Anesthesia, Hospital Privado de Comunidad, Córdoba 4545, 7600, Mar Del Plata, Buenos Aires, Argentina.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Tusman
authors.affiliation: Department of Anesthesia, Hospital Privado de Comunidad, Córdoba 4545, 7600, Mar Del Plata, Buenos Aires, Argentina.
authors.forename: Mauro
authors.initials: M
authors.lastname: Costantini
authors.affiliation: Department of Radiology, Hospital Privado de Comunidad, Mar Del Plata, Buenos Aires, Argentina.
authors.forename: Camila
authors.initials: C
authors.lastname: Echevarría
authors.affiliation: Department of Pediatric Surgery, Hospital Privado de Comunidad, Mar Del Plata, Buenos Aires, Argentina.
authors.forename: Sergio
authors.initials: S
authors.lastname: Pollioto
authors.affiliation: Department of Pediatric Surgery, Hospital Privado de Comunidad, Mar Del Plata, Buenos Aires, Argentina.
authors.forename: Diego
authors.initials: D
authors.lastname: Abrego
authors.affiliation: Section of Anesthesia and Critical Care Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.|CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Suarez-Sipmann
authors.affiliation: Swisstom AG, Landquart, Switzerland.
authors.forename: Stephan H
authors.initials: SH
authors.lastname: Böhm
keywords: Atelectasis; Children; Intra-pulmonary shunt; Lung ultrasound; Recruitment maneuvers