Bedside sonographic diagnosis of pneumothorax in pediatric patients. Vincenthealthandhospitals boardcertifiedemsphysician itsnotjustfor. Ultrasound has a higher sensitivity than the traditional upright anteroposterior chest radiography cxr for the detection of a pneumothorax. Pitfalls in the ultrasonographic diagnosis of pneumothorax. The major sonographic presentations of pneumothorax are summarized in table 1. The overall specificity of chest ultrasound in the diagnosis of pneumothorax in. Treatment of a tension pneumothorax is one of the classic medical emergencies where life can be saved or lost on the basis of recognition and subsequent rapid decompression.
A total of 357 hemithoraces were analyzed in this study, 47 with occult pneumothorax and. Pneumothorax, also called a collapsed lung, is when air gets between one of your lungs and the wall of your chest. Ultrasound diagnosis of pneumothorax relies on the recognition of four sonographic artifact signs. The diagnostic value of the sonographic signs of pneumothorax is similar to the wellknown and largely used radiologic signs of the same condition in chest radiography. 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. Sonographic diagnosis of pneumothorax, intensive care. The use of tus as a pointofcare test enables the respiratory physician to quickly and accurately diagnose pleural pathology and ensure safe access to the pleural space during thoracentesis or chest drain insertion. The diagnosis of pneumothorax was made with sonography. Ultrasound is a modality now available to all physicians and can help in making rapid decisions, particularly with critically ill patients. The sonographic diagnosis of pneumothorax consists in.
Efficacy of ultrasound in the diagnosis of pleurodesis in. Customize your jama network experience by selecting one or more topics from the list below. Ouellet jf, ball cg, panebianco nl, kirkpatrick aw. Pdf firstline sonographic diagnosis of pneumothorax in. Ultrasound evaluation of the magnitude of pneumothorax. It is a wellrecognized medical emergency condition with high mortality rates, especially in neonates with associated risk factors 1, 2, 3. Pdf traumatic pneumothorax detection with thoracic us. Instead of this timeconsuming manual assessment of. Unusual new signs of pneumothorax at lung ultrasound. Lung ultrasonography to diagnose pneumothorax of the newborn. Accuracy of ultrasound in diagnosis of pneumothorax. Accuracy of transthoracic sonography in excluding postinterventional pneumothorax and hydropneumothorax. The study population included 200 consecutive undifferentiated intensive care unit patients who received a chest computed tomography scan in addition to ultrasound and chest radiograph.
Springer nature is making sarscov2 and covid19 research free. The vline is a useful sonographic sign to aid the diagnosis of pleural free fluid. Combining these few signs, it is possible to accurately rule in. Symptoms typically include sudden onset of sharp, onesided chest pain and shortness of breath. 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. Indeed, kristensen says ultrasound should be the first diagnostic approach when a pneumothorax is suspected intraoperatively or during initial trauma evaluation. 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. Definition of pneumothorax open and closed pneumothorax. The presence of some sonographic signs, such as lung sliding, lung pulsation, or even a single b. Pneumothorax diagnosis and treatment online medical library. Bedside diagnostic ultrasound for traumatic pneumothorax is easy and reliable.
While ct scan is considered the gold standard for diagnosis, ultrasound is an ideal modality in the ed, given its rapid availability, portability, and reproducibility in assessing clinical status changes. Fortyseven consecutive cases of radioccult pneumothorax were compared with 310 consecutive hemithoraces free from pneumothorax in the intensive care unit. Suddenonset abdominal pain in a 76yearold woman with. Unusual new signs of pneumothorax at lung ultrasound the. Pneumothorax is a serious potential consequence of blunt thoracic trauma and, if misdiagnosed, it may quickly become lifethreatening for a discussion on epidemiology, clinical presentation, pathology, and treatment and prognosis please see the main pneumothorax article. In this post i link to and excerpt from sonographic diagnosis of pneumothorax pubmed abstract full text html. Pointofcare sonographic imaging often emphasizes the diagnostic. 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. Sonographic diagnosis of pneumothorax springerlink. Anatomical locations of air for rapid diagnosis of pneumothorax in.
International expert consensus and recommendations for. Sonographic diagnosis of a pneumothorax inapparent on. Sonographic diagnosis of a pneumothorax inapparent on plain. Jan 28, 2020 definition of pneumothorax open and closed pneumothorax. 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. Diagnosis of pneumothorax by radiography and ultrasonography. Home april 2001 volume 50 issue 4 sonographic diagnosis of a pneumothorax inapparent on plain.
Chest ultrasonography for the emergency diagnosis of. Our report is unique in that the sonographic diagnosis was confirmed with ct scan, suggesting that thoracic ultra. Role of thoracic sonographic scan in diagnosis of pneumothorax article pdf available in international journal of medical physics, clinical engineering and radiation oncology 4. The treatment of recurrent pleural effusion or recurrent pneumothorax frequently involves the creation of a pleurodesis. However, to our knowledge, a case report on the utility of bedside lung sonography in patients receiving hfov for the diagnosis of a pneumothorax has not been published previously. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. Pdf role of thoracic sonographic scan in diagnosis of. The conventional stepbystep sonographic technique and the four conventional ultrasound signs of pneumothorax should be slightly modified. Practical approach to lung ultrasound bja education. Bedside sonographic diagnosis of pneumothorax in pediatric. The sonographic diagnosis of pneumothorax ouellet jf, ball cg. Sonographic diagnosis of bilateral pneumothorax following an.
This normally air free 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. Pneumothorax ptx is defined as the presence of air within the pleural space. Classic indications include imaging for acute abdominal aneurysm, acute cholecystitis, hydronephrosis. 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. Previously, the diagnosis of a abstrusus via fineneedle biopsy is described in two cats. Links to and excerpts from sonographic diagnosis of. 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. Delivery occurs at 3034 weeks and, as there is a high risk of asphyxia, an experienced neonatal intensive care unit team should be present at delivery. Pleural effusion, pneumothorax and contusion of the lung 18% are found in. Pneumothorax ultrasound radiology reference article.
Prenatal sonographic signs of ips are separation of the membranes, echogenic amniotic fluid and echo. Lung sonography as a bedside tool for the diagnosis of a. Ct is considered the goldstandard in the diagnosis of pneumothorax. We constructed the forest plots with freeware metadisc, version 1.
Thoracic ultrasound in the modern management of pleural. Nov 20, 2010 sonographic diagnosis of pneumothorax sonographic diagnosis of pneumothorax volpicelli, giovanni 20101120 00. Ultrasound has a higher sensitivity than the traditional upright anteroposterior chest radiography cxr for the detection of a. In a pneumothorax, there is air present that separates the visceral and parietal pleura and prevents visualization of the visceral pleura. Abstract the ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. Sonographic diagnosis of pneumothorax husain lf, hagopian. 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. A pneumothorax collapsed lung, dropped lung is the entry of air into the pleural space the space between the lungs and chest wall. Chest radiography cxr is currently the first diagnostic method when clinical examination does not indicate immediate thoracostomy. When air enters this area, the lung loses contact with the inside of the chest and drops down. Dec 05, 2019 returning now to the excerpts from sonographic diagnosis of pneumothrorax. Because of its increasing use in the clinical practice, observations of some unusual and complicated cases are also emerging. In a minority of cases the amount of air in the chest increases when a oneway valve is formed by an area of damaged tissue, leading to a tension pneumothorax. 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.
The role of chest ultrasonography in the management of. 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. Management of pneumothoraxupdate with emphasis on interventional and minimally invasive procedures pnomotoraks yonetimigirisimsel ve minimal invazif islemler icin guncelleme abstract pneumothorax is a disease of the lung, defined as the presence of air in the pleural space. Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in. Ultrasound for detection of pneumothorax rebel em emergency. Combining these few signs, it is possible to accurately rule in or rule out. Our report demonstrates a successful diagnosis of a small pneumothorax with ultrasound in a patient with blunt trauma, which was not detected by a standard ap supine chest radiograph. Sonographic signs, including lung sliding, blines or comet tail artifacts, alines, and the lung point. Lung ultrasonography to diagnose pneumothorax of the. Firstline sonographic diagnosis of pneumothorax in major. For a discussion on epidemiology, clinical presentation, pathology, and treatment and prognosis please see the main pneumothorax article. Prompt and accurate diagnosis of a pneumothorax in the management of a critical patient.
The sonographic diagnosis in this case preceded diagnosis by. The diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology. Ultrasound of the pleurae and lungs ultrasound in medicine. If you are going to do a needlecannula decompression, this is a great time to measure chest wall. Pneumothorax is a serious potential consequence of blunt thoracic trauma and, if misdiagnosed, it may quickly become lifethreatening.
It can be used to complete and widen the general objective examination also in emergency situations, at the patients bedside. One important, wellestablished application is the diagnosis of a pneumothorax. Classic indications include imaging for acute abdominal aneurysm, acute cholecystitis, hydronephrosis, and free intraabdominal fluid in patients with trauma or suspected vascular or ectopic pregnancy rupture. Lung ultrasound is nowadays acknowledged as a useful methodology for the diagnosis of pneumothorax at bedside. A rapid diagnosis of pneumothorax and haemothorax is essential in trauma patients, since chest drainage can be lifesaving. In most cases, a combination of these signs allows a safe. Westergaardb emergency ultrasonography is a frequently used imaging tool in the bedside diagnosis of the acute abdomen. Ultrasound is being used more frequently to assess the presence of pleural fluid or pneumothorax. We studied the sonographic findings of pneumothorax in children and examined the patients with chest pain andor dyspnea in our pediatric emergency department. Nov 20, 2010 ultrasound diagnosis of pneumothorax relies on the recognition of four sonographic artifact signs. Jun 01, 2011 the bedside sonographic diagnosis of pneumothorax can be performed with most ultrasound machines without the need of any sophisticated functions.
The sonographic diagnosis of pneumothorax ouellet jf, ball. But it has been rarely described in literatures about the accuracy of sonographic signs specific to pneumothorax. Combining these few signs, it is possible to accurately rule in or rule out pneumothorax at the bedside in several different clinical scenarios. Sonographic diagnosis of pneumothorax sonographic diagnosis of pneumothorax volpicelli, giovanni 20101120 00. Thoracic sonography appears to be a promising technique for the exclusion of pneumothorax when chest radiography is delayed. Cxr for diagnosis of pneumothorax in trauma patients in the emergency department. Pdf sonographic diagnosis of pneumothorax researchgate. Color and power doppler sonography for pneumothorax detection. Aug 24, 2012 the vline sign is a result of the fluid acting as an acoustic window to enable visualization of vertebral bodies and posterior thoracic wall, thus confirming the presence of pleural fluid. The content on the uptodate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Bedside lung sonography has been used in the diagnosis of a pneumothorax in critically ill patients. When evaluation of lung sliding is combined with evaluation of other sonographic signs such as blines, lung pulse, and lung point, the specificity of ultrasound for pneumothorax is greatly increased. Development of thoracic ultrasound made it a useful tool for diagnosing respiratory disorders.
Sonographic signs of complex pneumothorax double lung point. Patients included in this study were those patients without pneumothorax on chest radiographs, who underwent an ultrasound screening examination in addition to a chest ct showing either occult pneumothorax pneumothorax group or absence of pneumothorax control group. Prompt and accurate diagnosis of a pneumothorax in the management of a critical patient can prevent the progression into a lifethreatening situation. Sonographic diagnosis of a pneumothorax inapparent on plain radiography. Sonographic features of pneumothorax include the absence of lung sliding, presence of alines and the lung point, with the absence of blines. With ultrasound, the gliding sign displays the gliding of the visceral pleura over the parietal pleura during respiration. A pneumothorax is an abnormal collection of air between the parietal and visceral layers of pleura. Sonographic diagnosis of pneumothorax husain lf, hagopian l. Pdf lung sonography has rapidly emerged as a reliable technique in the evaluation of various thoracic diseases. J emerg trauma shock serial online 2011 cited 2020 mar 21. The pressure causes the lung to give way, at least partly. Chest ultrasonography can be a useful diagnostic tool for respiratory physicians. Numerous techniques exist, and the literature is replete with opinions, but in the first instance relieving the tension, even if not draining the pneumothorax, is lifesaving.
Sonographic diagnosis of bilateral pneumothorax following. Firstline sonographic diagnosis of pneumothorax in major trauma. 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 bilateral pneumothorax following an acupuncture session allison harriott md department of emergency medicine, suny downstatekings county hospital center, brooklyn, ny, 11203. Pneumothorax refers to a collection of air in the pleural space, the potential between the lungs. Lus diagnosis was based on recognized sonographic signs of pneumothorax including.
Sonographic signs, including lung sliding, blines or comet tail artifacts, alines, and the lung point sign can help in the diagnosis of a pneumothorax. Patients with any lung disorder were excluded as control group. Volume 50 issue 4 sonographic diagnosis of a pneumothorax inapparent on plain. The above article has been cited by 16 pubmed central articles here are excerpts from the article. Diagnosis of a pneumothorax by physical examination alone can be difficult particularly in smaller pneumothoraces. Prenatal sonographic assessment and perinatal course of. Three signs were investigated at the anterolateral chest wall in supine patients. Pneumothorax critical care medicine jama jama network.
Physicianled thoracic ultrasound tus has substantially changed how respiratory disorders, and in particular pleural diseases, are managed. Pneumothorax diagnosis and treatment online medical. The advantages of sonography are that it is a relatively inexpensive, widely available, mobile form of multiplanar imaging free from ionizing. The incidence of ptx is reported to be 12% in term infants and 6% in premature infants with respiratory distress 2, 3. Each patient underwent thoracic ultrasound and chest radiography on the anterior and lateral chest. Eight patients with pneumothorax and 30 with pneumothorax free were enrolled. A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. The aim of this document is to promote better knowledge and more widespread use of thoracic ultrasound among respiratory physicians in italy. Early detection of pneumothorax is important for determining management and disposition in trauma patients. A preliminary report chiawang tang 1, kaisheng hsieh1 1division of pediatric pulmonology, department of pediatrics, kaohsiung veterans general hospital, national yangming university, taipei, taiwan original article. Chest ultrasonography versus supine chest radiography for. This air may be free beneath the parietal pleural ptx no sliding or contained within normal visceral pleura.