Sonographic signs, including lung sliding, blines or comet tail artifacts, alines, and the lung point sign can help in the diagnosis of a pneumothorax. All patients admitted to the intensive care unit are routinely scanned with whole. Find the top 100 most popular items in amazon books best sellers. Using thoracic ultrasonography to accurately assess pneumothorax progression during positive pressure ventilation.
Diagnosis of pneumothorax by radiography and ultrasonography. Chest ultrasonography a quick and accurate diagnostic tool. The increased sensitivity of us is echoed throughout the literature. Ultrasonography is being increasingly utilized in acute care settings with expanding applications. Jun 01, 2011 pneumothorax on ultrasound fast exam explained clearly duration. Mar 29, 2017 in neonates with pneumothorax, 15, 16, 17 ultrasound has been found in some studies to be comparable to chest radiography. 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.
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. The major sonographic presentations of pneumothorax are summarized in table 1. Lung pointthe most specific sign for pneumothorax on thoracic ultrasound. 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.
Oveland np, lossius hm, wemmelund k, stokkeland pj, knudsen l, sloth e. Pneumothorax is a serious potential consequence of blunt thoracic trauma and, if misdiagnosed, it may quickly become lifethreatening. 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. Mmode of lung point showing both seashore and stratosphere. In most cases, a combination of these signs allows a safe diagnosis of. Ultrasound diagnosis of pneumothorax relies on the recognition of four sonographic artifact signs.
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. Ultrasound diagnosis of chest diseaseses intechopen. Medical ultrasound also known as diagnostic sonography or ultrasonography is a diagnostic imaging technique, or therapeutic application of ultrasound. Sep 23, 20 ultrasonography is being increasingly utilized in acute care settings with expanding applications. Unusual new signs of pneumothorax at lung ultrasound the. This suggests that other providers can be trained to quickly perform ultrasonographic scanning and to recognize a suspected pneumothorax with sonography. This book is distributed under the terms of the creative commons. In addition to the sonographic features of pneumothorax. Ultrasound has a higher sensitivity than the traditional upright anteroposterior chest radiography cxr for the detection of a pneumothorax. Moreover, ultrasonographyassisted interventions can be performed by a single clinician without sedation and with minimal monitoring. When scanning the lungs it is recommended to scan in the. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Pdf lung sonography has rapidly emerged as a reliable technique in the evaluation of.
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. Pneumothorax on ultrasound fast exam explained clearly duration. At our institution, we wait for a chest xray that shows no pneumothorax before sending a patient to the ct scanner. The linear probe is the one we want to use for lung ultrasound examination. In neonates with pneumothorax, 15, 16, 17 ultrasound has been found in some studies to be comparable to chest radiography. Despite this, several aspects are yet to be studied and assessed, and international consensus remains limited. Several particular features on ultrasonography of the chest can be used to confirm or exclude the diagnosis. Ct computed tomography ct is the most sensitive and specific test for diagnosis of pneumothorax and is now considered the standard of reference. A study by cattarossi et al found that ultrasound was able to detect pneumothorax in all 23 affected patients. By definition, a persistent pneumothorax constitutes ongoing bubbling of air from an in situ chest drain, 48 h after its insertion. Home books advancements and breakthroughs in ultrasound imaging. Chest us may be help in the diagnosis of pneumothoraces. Symptoms typically include sudden onset of sharp, onesided chest pain and shortness of breath. All patients admitted to the intensive care unit are routinely scanned with wholebody ultrasound including screening for pneumothorax and chest radiography.
Efast was also compared to cxr, using ct scan as the gold. Our prior research concluded that ultrasonography allows for a significantly quicker diagnosis of pnx compared with cr and ct scanning. Thoracic ultrasound is now considered an essential bedside tool in. Ct is considered the goldstandard in the diagnosis of pneumothorax. 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. In certain locations, prehospital providers are adopting its use for the management of critically ill patients. 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. 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. Numerous techniques exist, and the literature is replete with opinions, but in the first instance. This study compares, by metaanalysis, the use of anteriorposterior chest radiography cr with transthoracic ultrasonography for the diagnosis of pneumothorax. In 10 patients with spontaneous pneumothorax, dynamic 320detector row ct was performed with injection of 0. Methods englishlanguage articles on the performance of cr and ultrasonography in the diagnosis of a pneumothorax were selected. Introduction to pulmonary ultrasound by critical care. May 25, 2017 the use of bedside ultrasound has revolutionized patient care.
Chest ultrasonography a quick and accurate diagnostic. Pleural ultrasonography versus chest radiography for the. 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. Bedside thoracic ultrasound examination of a 70 year old man who had an acute. 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.
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. The major advantages of thoracic ultrasound include bedside availability, absence of radiation, and realtime guidance for therapeutic interventions. Pneumothoraces ptxs are among the most common lifethreatening. This was an educational study evaluating 33 ems providers. 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. At that time, most cases of pneumothorax were secondary to tuberculosis, although some were recognised as occurring in otherwise healthy patients pneumothorax simple. To determine the sensitivity and specificity of emergency medical service ems providers in identifying pneumothorax on ultrasound examinations. Apr 21, 2016 the role of ultrasound towards identifying the aetiology of a persistent pneumothorax is however, not well studied.
Prior to ultrasound, patients with suspected traumatic pneumothorax were evaluated with chest radiography. 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 diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology. 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. In most cases, a combination of these signs allows a safe diagnosis of pneumothorax. Pdf sonographic diagnosis of pneumothorax researchgate. In their study of 225 trauma patients, the sensitivity of cr objective.
Stepbystep instructions describe criteria for each ultrasound study, then provide examples of each scan that should be obtained to complete the study. Semiquantification of pneumothorax volume by lung ultrasound. Transthoracic ultrasound us is useful in the evaluation of a wide range of peripheral parenchymal, pleural, and chest wall diseases. Thoracic ultrasound is now considered an essential bedside tool in respiratory medicine. Medcram medical lectures explained clearly 35,658 views. Bedside ultrasonography for diagnosis of pneumothorax. It turns out that in this patient he actually had a very large left pneumothorax. When compared to ultrasonography, studies show that ultrasound is a superior diagnostic tool in detection of traumatic thoracic injuries e. Ultrasound may also provide a rapid diagnosis in other emergency situations, and allow the quantification of the size of the pneumothorax.
Thoracic ultrasound can quickly diagnose pneumothorax not only in the. Pneumothorax on ultrasound fast exam explained clearly. A chest tube is placed and the remainder of the trauma survey proceeds. The bilateral, anterior discovery of sliding lung is sufficient to rule out pneumothorax in the vast majority of cases. Pneumothorax ultrasound radiology reference article. Lung ultrasonography to diagnose pneumothorax of the newborn. It allows for realtime and mobile assessment of thoracic disorders and can potentially augment the physical examination of the chest. A pneumothorax, often seen in the er, is one condition particularly dependent on a quick diagnosis. Us examination of the chest wall and parietal pleura can reveal a number of. Chest ultrasonography, pneumothorax, ct scan, bullous emphysema, radiooccult pneumothorax. Lung ultrasound diagnostic accuracy in neonatal pneumothorax. 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%. Nov 21, 2012 transthoracic ultrasound us is useful in the evaluation of a wide range of peripheral parenchymal, pleural, and chest wall diseases.
Persistent pneumothorax remains a diagnostic dilemma and identification of. Novel imaging detailing the origins of a pneumothorax thorax. Lung ultrasonography to diagnose pneumothorax of the. Pneumothorax can be missed by bedside radiography, and computed tomography is the current alternative. There are limitations, as there is neartotal reflection of sound waves at gas interfaces, hiding.
Pocket protocols for ultrasound scanning, 2nd edition. Rather than getting most of our information from visualizing the anatomy as in a ruq. Reasonable to obtain additional imaging to confirm pneumothorax if. Diagnosing pneumothorax with bedside ultrasound nuem blog. The use of bedside ultrasound has revolutionized patient care. Dec 19, 20 the diagnosis of pneumothorax with a bedside lung ultrasound is a powerful methodology. Lung ultrasound for pneumothorax family practice notebook. Moreover, ultrasonographyassisted interventions can be performed by a single clinician without sedation and with minimal monitoring, even. Summary transthoracic ultrasonography is a wellestablished, yet underutilised imaging modality in respiratory medicine. For those pneumothoraces occurring in neonates see the article on neonatal.
Pneumothorax ptx still remains a common cause of morbidity in critically ill and ventilated neonates. A practical guide to transthoracic ultrasound european. 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. Furthermore, it is increasingly used to guide interventional procedures of the chest and pleural space. For a discussion on epidemiology, clinical presentation, pathology, and treatment and prognosis please see the main pneumothorax article. 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. The lung point was identified on ultrasound imaging and referenced against the. Jun 01, 2011 studies have shown concordance between pneumothorax size on ultrasound and ct scan, reportedly within 1. Its aim is often to find a source of a disease or to exclude pathology. In primary spontaneous pneumothorax patients, ultrasoundguided pigtail catheter drainage is effective and had a shorter hospital stay than patients treated by chest tube drainage. 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.
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. The use of ultrasound to diagnose pneumothorax was first described in a veterinary medical journal in 1986 4. 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. 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. Trauma patients dependent on immediate diagnosis have particularly benefitted from quick ultrasoundguided bedside evaluation. The medical intensive care unit of a universityaffiliated teaching hospital. According to the literature, ultrasound us is superior to chest xray cxr in diagnosing pneumothorax. Pneumothorax evaluation by ultrasonography is a fast, safe, easy and inexpensive alternative to chest radiographs. Trauma patients dependent on immediate diagnosis have particularly benefitted from quick ultrasound guided bedside evaluation.
Introduction to pulmonary ultrasound by critical care specialist liz turner md. Chest ultrasonography can be used as a primary imaging modality in the diagnosis of pneumothorax in a vast variety of clinical situations. Deep vein thrombosis detection with ultrasound part 1 sonosite, inc. At the present time, lung ultrasound lus is not included in the diagnostic workup of ptx. Thoracic ultrasound has rapidly gained popularity over the past 10 years, mainly. We asked whether lung ultrasound could be of any help in this situation design. Thoracic and lung ultrasound statpearls ncbi bookshelf. 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. A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Lung ultrasound for pneumothorax, sliding lung sign, lung point. This article discusses the theoretical and practical aspects of using bedside ultrasonography for pneumothorax.