Ultrasound has a higher sensitivity than the traditional upright anteroposterior chest radiography cxr for the detection of a pneumothorax. Combined clinical examination and supine chest radiography have shown low accuracy in the assessment of pneumothorax in unstable patients with major chest trauma during the primary survey in the emergency room. We compared the test characteristics of ultrasonography and supine chest radiography in adult patients clinically suspected of having a pneumothorax, using ct scan or release of air on chest tube placement as. Definition of pneumothorax open and closed pneumothorax.
Symptoms typically include sudden onset of sharp, onesided chest pain and shortness of breath. Pneumothorax isdefined as the presence of air in the pleural. Combining these few signs, it is possible to accurately rule in or rule out pneumothorax at the bedside in several different clinical scenarios. Bedside diagnostic ultrasound for traumatic pneumothorax is easy and reliable. Because the amount of pneumothorax is small, the patient received oxygenation therapy and supportive care. Practical approach to lung ultrasound bja education. Intraoperative pneumothorax presenting as abdominal. Ultrasound evaluation of the magnitude of pneumothorax.
A 74yearold man with a history of lung cancer presented for right upper lobectomy. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. In most cases, a combination of these signs allows a safe diagnosis of. Chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax. Chest radiograph and computed tomography confirmed the diagnosis of pneumothorax figure 1b and c. The features of a pneumothorax are abolished sliding, absence of b lines, absence of the lung pulse, and presence of the lung point. After visualization of resolution of pneumothorax, chest radiography was performed to confirm the resolution. While both mmode and colour doppler sonography have been described as alternative modes in the examination of the pleura, no suggestion has been made so far that these modes might carry superior diagnostic capabilities in. Favourable experience with mmode sonography in the.
Most machines are now portable and can be brought to the bedside, which is especially helpful in the critically ill and hemodynamically unstable patient, as it obviates the need for transport. Sonographic diagnosis of bilateral pneumothorax following. Pdf firstline sonographic diagnosis of pneumothorax in. Lung ultrasonography to diagnose pneumothorax of the. Transthoracic sonography has emerged as a diagnostic tool in various diffuse and focal pulmonary diseases 25 and in pneumothorax and hydropneumothorax 68. Pneumothorax ptx is an emergency that requires urgent management to avoid catastrophic consequences. Furthermore, lung ultrasonography is a bedside, noninvasive and without radiation. The diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology. After induction of anesthesia, it was noted that the abdomen became progressively more distended. Their main use is when administering supplemental oxygen to patients with pneumothoraces secondary to copd. The time taken for diagnosing the presence or absence of pneumothorax by sonography usually possible by one or more sonographic signs ranged from 1 minute to 18 minutes.
It can be used to complete and widen the general objective examination also in emergency situations, at the patients bedside. In this short report, we describe the sonographic observation of the vertebral or vline to help confirm the presence of pleural fluid in the supine patient. Sonographic diagnosis of pneumothorax springerlink. Sonographic diagnosis of pneumothorax researchgate. Chest ultrasonography for the emergency diagnosis of. However, clinical interpretation of the presenting signs and symptoms is crucial for correctly diagnosing and treating the condition. Sonographic diagnosis of pneumothorax arterial blood gases arterial gas monitoring may demonstrate hypoxia 21 but the information gained is unlikely to alter the management plan. However, the thoracic anatomical locations to be examined are debateable. Sonographic diagnosis of pneumothorax sonographic diagnosis of pneumothorax volpicelli, giovanni 20101120 00. Unusual new signs of pneumothorax at lung ultrasound the. The bedside sonographic diagnosis of pneumothorax can be performed with most ultrasound machines without the need of any sophisticated functions. Sonographic diagnosis of bilateral pneumothorax following an acupuncture session sonographic diagnosis of bilateral pneumothorax following an acupuncture session harriott, allison. A leftsided thoracostomy was followed by insertion of an intercostal catheter, which failed to demonstrate pneumothorax or result in clinical improvement.
The role of chest ultrasonography in the management of. When abolishing lung sliding and the aline sign are combined fig. Indication for postdrain removal imaging after lung resection is debated. The major sonographic presentations of pneumothorax are summarized in table 1. Sonographic diagnosis of a pneumothorax inapparent on plain radiography. Sonographic diagnosis of bilateral pneumothorax following an acupuncture session allison harriott md department of emergency medicine, suny downstatekings county hospital center, brooklyn, ny, 11203. Our report is unique in that the sonographic diagnosis was confirmed with ct scan, suggesting that thoracic ultrasound may be more sensitive than routine chest radiography in the detection of small pneumothoraces. Diagnosis diagnosis of pneumothorax is done by thorough clinical examination and investigations. Typically, the initial evaluation of blunt trauma patients involves a supine anteroposterior ap chest xray cxr which has a poor sensitivity for the detection of pneumothorax ptx, and has been reported as low as 20% 48%. The sonographic diagnosis was correlated with supine. A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Sonographic diagnosis of bilateral pneumothorax following an acupuncture session. Timely and accurate confirmation or exclusion of ptx is of paramount importance in emergency and critical care. The low sensitivity of the chest xray in the diagnosis of pneumothorax and the various difficulties of performing the goldstandard ct, makes us an invaluable method for bedside use in the icu.
Pneumothorax diagnosis and treatment online medical. Medical personnel responding to an injured patient in a hostile environment must quickly assess the victim and attempt to exclude potentially lifethreatening injuries without the benefit of standard imaging modalities, such as radiography. Pneumothorax refers to a collection of air in the pleural space, the potential between the lungs. The aim of our study was to evaluate the diagnostic accuracy of extendedfocused assessment with sonography in trauma efast, in the diagnosis of pneumothorax. The lung is usually considered poorly accessible by sonography. The vline sign is a result of the fluid acting as an acoustic. This article is from critical ultrasound journal, volume 5. Sonographic features of pneumothorax include the absence of lung sliding, presence of alines and the lung point, with the absence of blines.
The average time taken by sonography for diagnosing presence or absence of pneumothorax in. In a minority of cases, a oneway valve is formed by an area of damaged tissue, and the amount of air in the space between chest wall and lungs increases. Pneumothoraces are the most common serious intrathoracic injury following blunt trauma1 and are a common cause of preventable morbidity and mortality. Ultrasound diagnosis of pneumothorax after fine needle. A prehospital paediatric tension viscerothorax presenting. Sonographic signs, including lung sliding, blines or comet tail artifacts, alines, and the lung point sign can help in the diagnosis of a pneumothorax.
After application of a pelvic splint and maintenance of spinal precautions, the child was transported by helicopter to a. It is rapid,carries no risk of radiation,a bedside diagnostic too. When it was diagnosed, pneumothorax was sonographically monitored. Although ct scan is the reference standard for diagnosis, chest radiographs are commonly used to rule out the diagnosis.
The aline sign, which is 100% sensitive for the diagnosis of pneumothorax 4, is in no case specific as the alines are also generated by physiologic air. Soon afterward, there was a significant decrease in tidal volume. Test characteristics of ultrasonography for the detection. We propose to introduce lung ultrasound lus as alternative to exclude significant pneumothorax ptx in this setting. Sonographic diagnosis of a pneumothorax inapparent on. Absence of these normal features indicated a pneumothorax. Ultrasound is more sensitive and specific than chest xray in the diagnosis of pneumothorax. Our experience confirms the limited ability of bmode sonography to confirm or exclude pneumothorax when thoracic subcutaneous emphysema is present. Sonographic diagnosis of pneumothorax, intensive care. Pneumothorax diagnosis and treatment milisavljevic slobodan,1, 2 spasic marko,1 milosevic bojan1 1 general and thoracic surgery clinic, clinical centre kragujevac, serbia 2 faculty of medical sciences university of kragujevac, serbia primljenreceived 20. Methods englishlanguage articles on the performance of cr and ultrasonography in the diagnosis of a pneumothorax were selected. Firstline sonographic diagnosis of pneumothorax in major. A pneumothorax is a potentially lifethreatening condition.
Following the cxr computed tomography ct has been the standard for the diagnosis of pneumothorax. Common early findings include1822 table 2 chest pain dyspnea. However, transthoracic sonography has been proven to be a useful method for the evaluation of pleural effusions, allowing detection of small volumes of pleural fluid 1, 2. Thoracic sonography appears to be a promising technique for the exclusion of pneumothorax when chest radiography is delayed. Combining these few signs, it is possible to accurately rule in or rule out pneumothorax at the bedside. The sonographic diagnosis of pneumothorax jeanfrancois ouellet, 1, 2 chad g ball, 1, 2 nova l panebianco, 4 and andrew w kirkpatrick 1, 2, 3 1 department of surgery, university of calgary, foothills medical centre, 1403, 29 th street nw, calgary, alberta, canada, t2n 2t9.
Chest ultrasonography can be a useful diagnostic tool for respiratory physicians. Placing the probe on the highest point of the anterior chest and demonstrating lung sliding will rule out a pneumothorax in only a few seconds. Pitfalls in the ultrasonographic diagnosis of pneumothorax. The diagnosis of pneumothorax with a bedside lung ultrasound is a powerful. We discuss the details of the case, the sonographic features of pneumothorax. The aim of this document is to promote better knowledge and more widespread use of thoracic ultrasound among respiratory physicians in italy. The conventional lung ultrasound examination consists of a stepbystep procedure targeted towards the detection of four classic ultrasound signs, the lung sliding, the b lines, the lung point and the lung pulse. This study compares, by metaanalysis, the use of anteriorposterior chest radiography cr with transthoracic ultrasonography for the diagnosis of pneumothorax. Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax. Combining these few signs, it is possible to accurately rule in or rule out pneumothorax at the bedside in. Sonographic diagnosis of pneumothorax with the presence of alines, the sensitivity and speci city for an occult pneumothorax is as high as 95 and 94%, respectively. Firstline sonographic diagnosis of pneumothorax in major trauma.
Anatomical locations of air for rapid diagnosis of. Pneumothorax is a common finding in the critically ill patients. Lung ultrasound to detect residual pneumothorax after. Ptx is also an important cause of respiratory failure in the emergency department and an annual rate of ptx is estimated at 22. Transthoracic sonography depicted all cases of pneumothorax and excluded pneumothorax in the other cases.
Bedside ultrasonography for diagnosis of pneumothorax. Thoracic ultrasound showed barcode sign over left lung in mmode and indicated the presence of pneumothorax. The sonographic signs of pneumothorax include the following. Ultrasound diagnosis of pneumothorax relies on the recognition of four sonographic artifact signs.
683 385 1027 1281 178 85 837 744 862 686 173 1503 1492 1201 690 246 739 1033 1083 1134 1183 801 1457 442 854 472 1421 986 881 51 355 403 1387 750 1069 1391 319 142 1440 1206 1482 1363 730 300 1231 1065 600