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Purpose: The diagnosis of community acquired pneumonia (CAP) is mainly based on the patient's medical history and physical examination. However, in some cases, a further evaluation including chest X-ray (CXR) may be necessary. At present, lung ultrasound (LUS) is not included in the diagnostic work-up of pneumonia. Our aim was to define the sensitivity of LUS in children with a clinical suspicion of pneumonia, compared to CXR.Methods: One-hundred and two children with clinical signs and symptoms suggesting pneumonia (53 males, age 1-16 years), who underwent a clinically-driven chest X-ray, were evaluated by LUS on the same day. A high-resolution linear probe with frequencies ranging from 6 to 12 MHz was employed.Results: LUS was positive for the diagnosis of pneumonia in 88/89 patients (sensitivity 99%), whereas CXR was positive in 81/89 (sensitivity 91%). In all patients with normal CXR and abnormal LUS, the clinical course was consistent with pneumonia. In the 13/102 patients with normal LUS and CXR, some other localization of the infection was found. LUS was superior to CXR also in detecting pleural effusion resulting from complicated pneumonia (16 vs 3 children, p<.001). The figure shows the typical appearance of a lung consolidation at LUS (panel B), compared to CXR (panel A).Conclusions: LUS is a simple and reliable tool for the diagnosis of pneumonia in children. It is more sensitive than CXR, can be easily repeated at the patient's bedside and does not use ionizing radiation. Given the high risk of the employment of ionizing radiation in the young population, this technique could become the routine imaging modality in children with suspected pneumonia.