Sonographic detection of radio-occult interstitial lung involvement in measles pneumonitis

We present the cases of 23- and 38-year-old healthy patients with clinical diagnosis of acute measles who experienced shortness of breath on exertion with nonproductive cough and showed signs of mild respiratory failure at presentation in the emergency department (ED) but with normal chest radiograph and auscultation. In both cases, bedside ultrasound of the lung showed the appearance of signs of interstitial diffuse involvement with vertical B lines spread all over the lateral and posterior chest wall. This sonographic pattern is typical of the interstitial involvement during acute viral pneumonitis that can be missed by physical examination and chest radiography. Even without radiologic infiltrates and pulmonary sounds, based on sonographic and arterial gas signs, a diagnosis of measles pneumonitis was done and patients admitted to the ward for close follow-up and supportive care. We hypothesize a new diagnostic role of bedside lung sonography in screening patients presenting to the ED with initial lung involvement in measles who warrant close follow-up and hospital admission.