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Sebbene per molti anni il polmone sia stato erroneamente considerato non esplorabile con gli ultrasuoni, nell’ultimo decennio l’ecografia toracica (ET) è stata applicata allo studio della patologia pleurica, degli addensamenti parenchimali e dell’interstizio polmonare nel paziente adulto. L’ET può risultare utile per chiarire la natura e la pertinenza anatomica di reperti radiografici dubbi, permettendo di distinguere tra addensamenti, atelettasie e versamenti pleurici; inoltre è la metodica di scelta per la valutazione longitudinale di queste condizioni. Il basso costo, la rapidità di esecuzione e la ripetibilità dell’indagine, oltre alle ovvie ragioni radioprotezionistiche, fanno sì che l’ET in campo pediatrico - soprattutto se direttamente eseguibile dal clinico al letto del paziente - si proponga come metodica di grande interesse, degna di approfondimenti e sviluppi.

Glycogenosis type II, a genetic muscle-wasting disorder, results in a spectrum of clinical phenotypes. Enzyme replacement therapy is effective in the infantile form of the disease, while little is known about its effectiveness in late-onset disease, especially in juvenile patients. The purpose of this retrospective cohort study was to assess the long-term effects of enzyme replacement therapy (ERT) in juvenile glycogenosis type II (GSDII). Eight Italian juvenile GSDII patients, receiving biweekly infusions of 20 mg/kg recombinant human α-glucosidase for at least 72 months, were enrolled (median age at therapy start was 11.8 years). Six-minute walk test (6MWT) and forced vital capacity (FVC), measured in upright position, were chosen as the principal outcome measures. Global motor disability (modified Walton scale (WS)), muscle enzymes levels [creatine phosphokinase (CK), lactate dehydrogenase (LDH), aspartate transaminase (AST), alanine transaminase (ALT)] and body mass index (BMI) were also analysed both at baseline (therapy start) and annually afterwards. At baseline, most patients (six out of eight) did not show muscle function impairment (WS ≤ 2). The performance at 6MWT showed a slight improvement during follow-up as well as FVC. Muscle enzymes levels showed a clear decrease after the 1st year of treatment while remained stable afterwards. An overall decrease in BMI was also observed during follow-up, although at the individual level, trends were variable. Conclusion: ERT is effective in stabilising both motor and lung functions in juvenile patients with GSDII, possibly slowing down the rate of disease progression. Randomised controlled trials are needed to understand whether early treatment allows juvenile patients to reach adulthood with a more beneficial residual muscular function than untreated patients.