• Erik Küng, Lukas Aichhorn, Angelika Berger, and Tobias Werther.
• All authors: Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University Vienna, Vienna, Austria.
• Pediatr Crit Care Me. 2020 Oct 1; 21 (10): e944-e947.

ObjectivesTo evaluate if "mirrored ribs"-a mirroring of chest structures-is a sign for pneumothorax in lung ultrasound in neonates.DesignRetrospective study.SettingMedical University Vienna/General Hospital, Vienna, Austria.PatientsAll neonates admitted with clinical signs of pneumothorax between July 2018 and February 2019.InterventionsChest radiograph and lung ultrasound in succession.Measurements And Main ResultsAnterior-posterior chest radiograph and lung ultrasound were compared. "Mirrored ribs" were defined as mirroring of at least one rib and intercostal muscles in B-mode in the absence of B-lines. Twenty-nine cases in 26 patients were considered. Pneumothorax was diagnosed in 55% of cases using reported signs for pneumothorax in lung ultrasound and in 31% using chest radiograph. Lung ultrasound identified all pneumothoraces visible in chest radiograph. "Mirrored ribs" were visible in all patients with signs for pneumothorax and in none without signs for pneumothorax in lung ultrasound, representing a specificity and sensitivity of 100% compared with reported signs for pneumothorax in lung ultrasound.ConclusionsThe occurrence of "mirrored ribs" in lung ultrasound in combination with absence of lung sliding, absence of B-lines and lung point might facilitate the rapid recognition of pneumothorax in neonates.

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