This was an educational study evaluating 33 ems providers. The role of chest us in the diagnosis of pneumothorax has been established, but comparison with lung computed tomography ct scanning has not yet been. The major sonographic presentations of pneumothorax are summarized in table 1. Chest us may be help in the diagnosis of pneumothoraces. Jun 01, 2011 studies have shown concordance between pneumothorax size on ultrasound and ct scan, reportedly within 1. Home books advancements and breakthroughs in ultrasound imaging. Diagnosis of pneumothorax by radiography and ultrasonography. Thoracic ultrasound can quickly diagnose pneumothorax not only in the. Despite this, several aspects are yet to be studied and assessed, and international consensus remains limited. Ultrasound may also provide a rapid diagnosis in other emergency situations, and allow the quantification of the size of the pneumothorax.
At that time, most cases of pneumothorax were secondary to tuberculosis, although some were recognised as occurring in otherwise healthy patients pneumothorax simple. Lung pointthe most specific sign for pneumothorax on thoracic ultrasound. With this in mind, the guest editors of this monograph have selected a broad range of authors who are recognised experts, represent different specialities and use thoracic ultrasound in different. Pdf lung sonography has rapidly emerged as a reliable technique in the evaluation of. A pneumothorax, often seen in the er, is one condition particularly dependent on a quick diagnosis. When scanning the lungs it is recommended to scan in the. Sonographic signs, including lung sliding, blines or comet tail artifacts, alines, and the lung point sign can help in the diagnosis of a pneumothorax. The use of ultrasound to diagnose pneumothorax was first described in a veterinary medical journal in 1986 4.
Ct is considered the goldstandard in the diagnosis of pneumothorax. Medical ultrasound also known as diagnostic sonography or ultrasonography is a diagnostic imaging technique, or therapeutic application of ultrasound. Ultrasound diagnosis of chest diseaseses intechopen. Chest ultrasonography can be used as a primary imaging modality in the diagnosis of pneumothorax in a vast variety of clinical situations. Moreover, ultrasonographyassisted interventions can be performed by a single clinician without sedation and with minimal monitoring, even. The lung point was identified on ultrasound imaging and referenced against the. Furthermore, it is increasingly used to guide interventional procedures of the chest and pleural space. For those pneumothoraces occurring in neonates see the article on neonatal. This suggests that other providers can be trained to quickly perform ultrasonographic scanning and to recognize a suspected pneumothorax with sonography. Medcram medical lectures explained clearly 35,658 views. Pneumothoraces ptxs are among the most common lifethreatening.
In certain locations, prehospital providers are adopting its use for the management of critically ill patients. At our institution, we wait for a chest xray that shows no pneumothorax before sending a patient to the ct scanner. Pdf sonographic diagnosis of pneumothorax researchgate. Symptoms typically include sudden onset of sharp, onesided chest pain and shortness of breath.
Mar 29, 2017 in neonates with pneumothorax, 15, 16, 17 ultrasound has been found in some studies to be comparable to chest radiography. This is a prospective clinical study aimed at introducing a method to visualise the location of an air leak and to identify the bulla responsible on threedimensional 3d cine ct. Pneumothorax is a serious potential consequence of blunt thoracic trauma and, if misdiagnosed, it may quickly become lifethreatening. Pneumothorax ptx still remains a common cause of morbidity in critically ill and ventilated neonates. When compared to ultrasonography, studies show that ultrasound is a superior diagnostic tool in detection of traumatic thoracic injuries e. In 10 patients with spontaneous pneumothorax, dynamic 320detector row ct was performed with injection of 0. Trauma patients dependent on immediate diagnosis have particularly benefitted from quick ultrasound guided bedside evaluation. The medical intensive care unit of a universityaffiliated teaching hospital. Using thoracic ultrasonography to accurately assess pneumothorax progression during positive pressure ventilation. Us examination of the chest wall and parietal pleura can reveal a number of.
Ultrasound diagnosis of pneumothorax relies on the recognition of four sonographic artifact signs. The increased sensitivity of us is echoed throughout the literature. Diagnosing pneumothorax with bedside ultrasound nuem blog. Methods englishlanguage articles on the performance of cr and ultrasonography in the diagnosis of a pneumothorax were selected. Apr 21, 2016 the role of ultrasound towards identifying the aetiology of a persistent pneumothorax is however, not well studied. Lung ultrasound for pneumothorax family practice notebook. Evaluation for pneumothorax is an important indication for obtaining chest radiographs in patients who have had trauma, recent cardiothoracic surgery or are on ventilator support. Persistent pneumothorax remains a diagnostic dilemma and identification of.
Introduction to pulmonary ultrasound by critical care. The scanning technique that should be employed in the emergency setting is the eightzone examination, consisting of scanning four chest areas per side figure 6. 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. Studies have shown concordance between pneumothorax size on ultrasound and ct scan, reportedly within 1. Ultrasound has a higher sensitivity than the traditional upright anteroposterior chest radiography cxr for the detection of a pneumothorax. Lung ultrasound diagnostic accuracy in neonatal pneumothorax. A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. May 25, 2017 the use of bedside ultrasound has revolutionized patient care. Mmode of lung point showing both seashore and stratosphere. In their study of 225 trauma patients, the sensitivity of cr objective.
Flipcard format with spiral binding allows the book to sit upright close to the console, so sonographer can easily flip pages while scanning to be sure that correct protocols are followed. Chest ultrasonography a quick and accurate diagnostic. Rather than getting most of our information from visualizing the anatomy as in a ruq. Thoracic ultrasound has rapidly gained popularity over the past 10 years, mainly. In primary spontaneous pneumothorax patients, ultrasound guided pigtail catheter drainage is effective and had a shorter hospital stay than patients treated by chest tube drainage. In addition to the sonographic features of pneumothorax.
Prior to ultrasound, patients with suspected traumatic pneumothorax were evaluated with. Chest ultrasonography, pneumothorax, ct scan, bullous emphysema, radiooccult pneumothorax. Ultrasound has become a key adjunct for the initial evaluation of trauma patients in the emergency department ed, with the efast, or extended focused assessment with sonography in trauma examination, including lung evaluation for the presence of a pneumothorax ptx or hemothorax. For a discussion on epidemiology, clinical presentation, pathology, and treatment and prognosis please see the main pneumothorax article. Unusual new signs of pneumothorax at lung ultrasound the. Thoracic and lung ultrasound statpearls ncbi bookshelf. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. In primary spontaneous pneumothorax patients, ultrasoundguided pigtail catheter drainage is effective and had a shorter hospital stay than patients treated by chest tube drainage. Ultrasonography is being increasingly utilized in acute care settings with expanding applications.
Nov 21, 2012 transthoracic ultrasound us is useful in the evaluation of a wide range of peripheral parenchymal, pleural, and chest wall diseases. A practical guide to transthoracic ultrasound european. Oveland np, lossius hm, wemmelund k, stokkeland pj, knudsen l, sloth e. Summary transthoracic ultrasonography is a wellestablished, yet underutilised imaging modality in respiratory medicine. In neonates with pneumothorax, 15, 16, 17 ultrasound has been found in some studies to be comparable to chest radiography. Ct computed tomography ct is the most sensitive and specific test for diagnosis of pneumothorax and is now considered the standard of reference. Ultrasound is an important tool for recognizing pneumothorax, particularly in the unstable or supine patient, as pneumothoraxes can be difficult to detect on plain renal function tests may be needed for patients receiving intravenous iv contrast for imaging studies. Pocket protocols for ultrasound scanning, 2nd edition. The linear probe is the one we want to use for lung ultrasound examination. 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. 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%.
Lung ultrasound for pneumothorax, sliding lung sign, lung point. Efast was also compared to cxr, using ct scan as the gold. Pneumothorax on ultrasound fast exam explained clearly. The term pneumothorax was first coined by itard and then laennec in 1803 and 1819 respectively,1 and refers to air in the pleural cavity ie, interspersed between the lung and the chest wall. In most cases, a combination of these signs allows a safe diagnosis of. 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.
Ultrasound is of proven accuracy in the diagnosis of pneumothorax. Prior to ultrasound, patients with suspected traumatic pneumothorax were evaluated with chest radiography. Dec 19, 20 the diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology. The use of bedside ultrasound has revolutionized patient care. Pneumothorax ultrasound radiology reference article. According to the literature, ultrasound us is superior to chest xray cxr in diagnosing pneumothorax.
The detection of pneumothorax with sonography in the past, sonography had always been used for obgyne cases. When this collection of gas is constantly enlarging with resulting compression of mediastinal structures, it can be lifethreatening and is known as a tension pneumothorax if no tension is present it is a simple pneumothorax. This study compares, by metaanalysis, the use of anteriorposterior chest radiography cr with transthoracic ultrasonography for the diagnosis of pneumothorax. In most cases, a combination of these signs allows a safe diagnosis of pneumothorax. Jun 01, 2011 pneumothorax on ultrasound fast exam explained clearly duration. Jul 04, 2014 the scanning technique that should be employed in the emergency setting is the eightzone examination, consisting of scanning four chest areas per side figure 6. Although the focused assessment with sonography in trauma fast examination has been part of advanced trauma life support atls for over a decade, the addition of pneumothorax evaluation to this protocol to create the extended fast efast examination is a relatively. We asked whether lung ultrasound could be of any help in this situation design. Chest ultrasonography a quick and accurate diagnostic tool. This book is distributed under the terms of the creative commons. It is used to create an image of internal body structures such as tendons, muscles, joints, blood vessels, and internal organs.
Another study, by raimondi et al, found that in 26 critically ill newborns, sensitivity, specificity, positive. Traditionally, thoracic ultrasound was limited to exploration of pleural effusion, but with the availability of modern and smaller handheld units, the range of applications has broadened. By definition, a persistent pneumothorax constitutes ongoing bubbling of air from an in situ chest drain, 48 h after its insertion. Patients included in this study were those patients without pneumothorax on chest radiograph s, w h o u n derw en t an u ltrasou n d. There are limitations, as there is neartotal reflection of sound waves at gas interfaces, hiding. It turns out that in this patient he actually had a very large left pneumothorax. Using thoracic ultrasonography to accurately assess. All patients admitted to the intensive care unit are routinely scanned with wholebody ultrasound including screening for pneumothorax and chest radiography.
Deep vein thrombosis detection with ultrasound part 1 sonosite, inc. Pneumothorax can be missed by bedside radiography, and computed tomography is the current alternative. Lung ultrasonography to diagnose pneumothorax of the newborn. Numerous techniques exist, and the literature is replete with opinions, but in the first instance.
The chest radiograph is only between 3060% sensitive for pneumothorax and you can kind of see why when someone is laying on a backboard or stretcher and the lung falls posteriorly, that you wont see it well on an anterior posterior chest radiograph. Novel imaging detailing the origins of a pneumothorax thorax. Moreover, ultrasonographyassisted interventions can be performed by a single clinician without sedation and with minimal monitoring. This article discusses the theoretical and practical aspects of using bedside ultrasonography for pneumothorax. Its aim is often to find a source of a disease or to exclude pathology. Pneumothorax evaluation by ultrasonography is a fast, safe, easy and inexpensive alternative to chest radiographs. Patients were eligible if they had a chest ultrasound, supine radiography, and ct scan all obtained within 120 mins. Introduction to pulmonary ultrasound by critical care specialist liz turner md.
With more research done on the diagnostic procedure, the results have shown that sonography can be used for a variety of different cases not only confined to the reproductive system and the abdomen. 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. The bilateral, anterior discovery of sliding lung is sufficient to rule out pneumothorax in the vast majority of cases. A study by cattarossi et al found that ultrasound was able to detect pneumothorax in all 23 affected patients. Trauma patients dependent on immediate diagnosis have particularly benefitted from quick ultrasoundguided bedside evaluation. Chest cts were obtained at the discretion of the treating physician for a wide range of suspected diagnoses regardless of the ultrasound results table 1. Reasonable to obtain additional imaging to confirm pneumothorax if. At the present time, lung ultrasound lus is not included in the diagnostic workup of ptx. Ultrasound of the thorax noncardiac marthamoonlarson, dvm, ms ultrasound of the noncardiac thorax is an important supplemental imaging modality in the diagnosis of pulmonary, mediastinal, pleural, and chest wall disease. To determine the sensitivity and specificity of emergency medical service ems providers in identifying pneumothorax on ultrasound examinations. A chest tube is placed and the remainder of the trauma survey proceeds. The diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology.
Stepbystep instructions describe criteria for each ultrasound study, then provide examples of each scan that should be obtained to complete the study. Pleural ultrasonography versus chest radiography for the. Bedside ultrasonography for diagnosis of pneumothorax. Several particular features on ultrasonography of the chest can be used to confirm or exclude the diagnosis.
Transthoracic ultrasound us is useful in the evaluation of a wide range of peripheral parenchymal, pleural, and chest wall diseases. The major advantages of thoracic ultrasound include bedside availability, absence of radiation, and realtime guidance for therapeutic interventions. Our prior research concluded that ultrasonography allows for a significantly quicker diagnosis of pnx compared with cr and ct scanning. One way that we could represent the motion from lung sliding in a still image is to use mmode or motion mode, and this is where you take a one dimensional line put it across the pleural line and look at it over time and when you do that you can see that the portion of the image on the left has an area where there is motion represented in the inferior half of the field. Thoracic ultrasound is now considered an essential bedside tool in respiratory medicine. Moreover, usguided pigtail catheter for secondary spontaneous pneumothorax ssp is also effective and has low complication rate. Find the top 100 most popular items in amazon books best sellers. Semiquantification of pneumothorax volume by lung ultrasound. Sep 23, 20 ultrasonography is being increasingly utilized in acute care settings with expanding applications. It allows for realtime and mobile assessment of thoracic disorders and can potentially augment the physical examination of the chest.
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