Firstline sonographic diagnosis of pneumothorax in major trauma. 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. Ultrasound us is a valuable bedside tool in the intensive care setting for aiding diagnosis. Methods englishlanguage articles on the performance of cr and ultrasonography in the diagnosis of a pneumothorax were selected. Accuracy of transthoracic sonography in detection of. Anatomical locations of air for rapid diagnosis of. Sonographic diagnosis of a pneumothorax inapparent on plain radiography.
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. This pointofcare imaging method can be performed in conjunction with the clinical examination, and it can improve the sensitivity of the first diagnostic approach for these injuries. Lung ultrasonography to diagnose pneumothorax of the. Test characteristics of ultrasonography for the detection. A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. One important, wellestablished application is the diagnosis of a pneumothorax. Jan 28, 2014 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. Patients with preexisting pulmonary diseases may develop secondary spontaneous pneumothoraces. 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. Jan 01, 2014 sonographic diagnosis of bilateral pneumothorax following an acupuncture session sonographic diagnosis of bilateral pneumothorax following an acupuncture session harriott, allison. The sonographic diagnosis of pneumothorax ouellet jf, ball cg. Sonographic diagnosis of a pneumothorax inapparent on plain. Abstract the ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. Pneumothorax isdefined as the presence of air in the pleural.
Symptoms typically include sudden onset of sharp, onesided chest pain and shortness of breath. Bedside sonographic diagnosis of pneumothorax in pediatric. Test characteristics of ultrasonography for the detection of. Principles of diagnosis and management of traumatic pneumothorax. Conducting systematic sonographic examination of the anterior and posterior intercostal spaces on the side of biopsy or tube thoracostomy, those authors found 100% sensitivity and 100% specificity of transthoracic sonography in the diagnosis or exclusion of postinterventional pneumothorax. 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. The advantages of sonography are that it is a relatively inexpensive, widely available, mobile form of multiplanar imaging free from ionizing.
Ultrasound has a higher sensitivity than the traditional upright anteroposterior chest radiography cxr for the detection of a pneumothorax. 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. Performance of ultrasonography for the detection of pneumothorax is excellent and is superior to supine chest radiography. Diagnosis of pneumothorax by radiography and ultrasonography. Jun 16, 2014 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%. Furthermore, lung ultrasonography is a bedside, noninvasive and without radiation. Sonographic diagnosis of a pneumothorax inapparent on. 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. Technical equipment sonographic diagnosis pnxcan usingbasic technology anyprobe. Sonographic diagnosis of bilateral pneumothorax following. Sonographic diagnosis of bilateral pneumothorax following an acupuncture session allison harriott md department of emergency medicine, suny downstatekings county hospital center, brooklyn, ny, 11203.
Left perihilar consolidation extending to involve the left lower lobe, consistent with lung contusion, is present. Links to and excerpts from sonographic diagnosis of. In this post i link to and excerpt from sonographic diagnosis of pneumothorax pubmed abstract full text html. Nov 20, 2010 ultrasound diagnosis of pneumothorax relies on the recognition of four sonographic artifact signs. Pitfalls in the ultrasonographic diagnosis of pneumothorax. Firstline sonographic diagnosis of pneumothorax in major. Ultrasound is gaining popularity as a means to diagnose pneumothoraces at the bedside, owing to its increasing availability in a variety of clinical. Handheld portable sonography for the onmountain exclusion. 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. The role of chest ultrasonography in the management of. The aim of our study was to evaluate the diagnostic accuracy of extendedfocused assessment with sonography in trauma efast, in the diagnosis of pneumothorax. Pneumothorax as a complication of pleural catheter insertion could be very dangerous in patients under mechanical ventilation. In a pneumothorax, there is air present that separates the visceral and parietal pleura and prevents visualization of the visceral pleura.
The aim of our study was to evaluate the diagnostic accuracy of extendedfocused assessment with sonography in trauma efast, in the diagnosis of pneumothorax, compared with the. Ultrasonography application for detection and management of. For pneumothorax ex vacuo, in addition to the presence of a visceral pleural line, ipsilateral loss of volume and lung atelectasis are present. Sonographic diagnosis of bilateral pneumothorax following an.
Ultrasound is a modality now available to all physicians and can help in making rapid decisions, particularly with critically ill patients. Pdf firstline sonographic diagnosis of pneumothorax in. The sonographic signs of pneumothorax include the following. A pneumothorax can also be caused by physical trauma to the chest including a blast injury or as a complication of a healthcare intervention, in which case it is called a traumatic pneumothorax. The features of a pneumothorax are abolished sliding, absence of b lines, absence of the lung pulse, and presence of the lung point. Automated pneumothorax diagnosis using deep neural networks. Bedside diagnostic ultrasound for traumatic pneumothorax is easy and reliable. Diagnosis of a pneumothorax by physical examination alone can be difficult particularly in smaller pneumothoraces. This study compares, by metaanalysis, the use of anteriorposterior chest radiography cr with transthoracic ultrasonography for the diagnosis of pneumothorax. Ouellet jf, ball cg, panebianco nl, kirkpatrick aw. Without the other sonographic findings, this lung pulse sign could have mistakenly ruled out pneumothorax. 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.
The sonographic diagnosis of pneumothorax ouellet jf, ball. Keywords thoracic ultrasound major trauma extendedfast pneumothorax multidetector computed tomography introduction pneumothorax is a serious potential consequence of blunt thoracic trauma and, if misdiagnosed, it may quickly. The diagnosis was confirmed sonographically by an absence of lung sliding and the presence of the lung point sign at the eighth intercostal space. There are several different sonographic signs that can be used to detect pneumothorax, specifically, sonographic lung sliding. Giovannivolpicelli sonographic diagnosis pneumothoraxreceived. Because the amount of pneumothorax is small, the patient received oxygenation therapy and supportive care. Pneumothorax is a common finding in the critically ill patients. Blane, md respiratory distress in the neonate is a common problem. When it was diagnosed, pneumothorax was sonographically monitored. The sonographic diagnosis of pneumothorax consists in. We aimed to study the anatomical locations of blunt traumatic pneumothoraces as defined by chest ct scan to identify the areas that should be scanned while performing bedside diagnostic ultrasound. The major sonographic presentations of pneumothorax are summarized in table 1.
Sonographic diagnosis of bilateral pneumothorax following an acupuncture session. J emerg trauma shock serial online 2011 cited 2020 mar 21. Pneumothorax refers to a collection of air in the pleural space, the potential between the lungs. Dec 05, 2019 returning now to the excerpts from sonographic diagnosis of pneumothrorax. Sonographic features of pneumothorax include the absence of lung sliding, presence of alines and the lung point, with the absence of blines.
Request pdf sonographic diagnosis of pneumothorax over the last decade, the use of ultrasound as a technique to look for pneumothorax has rapidly evolved. This normally airfree space is located between the 2 pleurae, the parietal pleura lines the chest wall and the visceral pleura covers the lung directly from the outside. Pdf sonographic diagnosis of pneumothorax researchgate. Sonographic diagnosis of bilateral pneumothorax following an acupuncture session sonographic diagnosis of bilateral pneumothorax following an acupuncture session harriott, allison. Primary spontaneous pneumothoraces occur in young people without known respiratory illnesses. Following the cxr computed tomography ct has been the standard for the diagnosis of pneumothorax. Sonographic signs, including lung sliding, blines or comet tail artifacts, alines, and the lung point sign can help in the diagnosis of a pneumothorax. An inverted hemidiaphragm may be a significant factor contributing to the respiratory distress.
Many of the early references to pneumothorax may have been tension pneumothorax, which can be signi. Thoracic ultrasound showed barcode sign over left lung in mmode and indicated the presence of pneumothorax. Primary sonographic signs of pneumothorax include absent lungpleural sliding and presence of stratusphere sign. Simultaneous lung point and lung pulse in pneumothorax. Automated pneumothorax diagnosis using deep neural.
Practical approach to lung ultrasound bja education. We studied the sonographic findings of pneumothorax in children and examined the patients with chest pain andor dyspnea in our pediatric emergency department to determine the. Lung ultrasonography to diagnose pneumothorax of the newborn. A pneumothorax is a potentially lifethreatening condition. Home april 2001 volume 50 issue 4 sonographic diagnosis of a pneumothorax inapparent on plain. Diagnosis and signs of pneumothorax on ultrasound with. 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%. Jun 01, 2011 sonographic signs, including lung sliding, blines or comet tail artifacts, alines, and the lung point sign can help in the diagnosis of a pneumothorax. Although ct scan is the reference standard for diagnosis, chest radiographs are commonly used to rule out the diagnosis. This point of care imaging method can be performed in conjunction with the clinical examination, and it can improve the sensitivity of the first diagnostic approach for these injuries. Definition of pneumothorax open and closed pneumothorax. Jun 18, 2015 the features of a pneumothorax are abolished sliding, absence of b lines, absence of the lung pulse, and presence of the lung point. Sonographic diagnosis of neonatal diaphragmatic inversion. Pneumothorax diagnosis and treatment online medical.
After visualization of resolution of pneumothorax, chest radiography was performed to confirm the resolution. Sonographic diagnosis of pneumothorax springerlink. Lus diagnosis was based on recognized sonographic signs of pneumothorax including. Development of thoracic ultrasound made it a useful tool for diagnosing respiratory disorders. Combining these few signs, it is possible to accurately rule in or rule out pneumothorax at the bedside in. Chest ultrasonography for the emergency diagnosis of. The average time taken by sonography for diagnosing presence or absence of pneumothorax in. Chest radiograph and computed tomography confirmed the diagnosis of pneumothorax figure 1b and c. Combining these few signs, it is possible to accurately rule in or rule out pneumothorax at the bedside in several different clinical scenarios. Lung sonography has rapidly emerged as a reliable technique in the evaluation of various thoracic diseases.
Common early findings include1822 table 2 chest pain dyspnea. This suggests that other providers can be trained to quickly perform ultrasonographic scanning and to recognize a suspected pneumothorax with sonography. Sonographic diagnosis of neonatal diaphragmatic inversion dorit d. If there is a connection to the outside, either through the chest. 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. Principles of diagnosis and management of traumatic.
However, the thoracic anatomical locations to be examined are debateable. But it has been rarely described in literatures about the accuracy of sonographic signs specific to pneumothorax. However, clinical interpretation of the presenting signs and symptoms is crucial for correctly diagnosing and treating the condition. Transthoracic sonography depicted all cases of pneumothorax and excluded pneumothorax in the other cases. The above article has been cited by 16 pubmed central articles here are excerpts from the article. Pneumothorax, ultrasound, failure, sonographic, lung. Sonographic diagnosis of posttraumatic pneumothorax volume 50 number 4 751. 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 relies on the recognition of four sonographic artifact signs. Diagnosis diagnosis of pneumothorax is done by thorough clinical examination and investigations. View the article pdf and any associated supplements and figures for a period of. Pdf sonographic diagnosis of pneumothorax kristin carmody. Ultrasound for detection of pneumothorax rebel em emergency.
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