For the evaluation of blines, it is recommended to set the focus at the level of the pleural line. This may be useful since size of the lung collapse usually determines treatment and establishes the prognosis for the pneumothorax 2, 3. Diagnosing pneumothorax with bedside ultrasound nuem blog. The sonographic diagnosis of pneumothorax ncbi nih. Ultrasound examination of the thorax is superior to chest radiograph or physical examination for diagnosing common conditions such as pneumonia, pulmonary edema, pleural effusion, and pneumothorax.
Request pdf sonographic diagnosis of pneumothorax over the last decade, the use of ultrasound as a technique to look for pneumothorax has rapidly evolved. Perioperative pointofcare ultrasonography anesthesiology. Sonographic diagnosis of a pneumothorax inapparent on plain radiography. Sonography of iatrogenic pneumothorax in pediatric patients. Brook or, beckrazi n, abadi s, filatov j, ilivitzki a, litmanovich d, gaitini d. Our case report revealed how chest ultrasound can detect and monitor pneumothorax as a complication of pleural catheter insertion 10, 11. Pneumothorax is traditionally diagnosed by chest radiography, ultrasound is fairly a new modality of diagnosis. Links to and excerpts from sonographic diagnosis of. The bilateral, anterior discovery of sliding lung is sufficient to rule out pneumothorax in. It can be argued that the efficacy of ultrasonography us for. Sonographic diagnosis of a pneumothorax inapparent on plain. A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall.
The basic skill set is straightforward to learn, quick to perform, repeatable, and does not involve patient transport, harmful ionizing radiation, or waiting time. In eligible studies, data were recalculated, and the forest plots and summary receiver operating characteristic sroc curves were analyzed. Sonographic diagnosis of pneumothorax researchgate. Lus compared with other methods in the diagnosis and followup of cap in adults sonomorpholyog. Unusual new signs of pneumothorax at lung ultrasound the. Combining these few signs, it is possible to accurately rule in or rule out pneumothorax at the bedside in several different clinical scenarios. Fortunately, us can provide realtime information at the bedside in only seconds.
Lung sliding sign it is a dynamic ultrasound artefact that appears on a socalled pleural line which physiologically consists of the parietal pleura, pulmonary pleura and a slight amount of fluid between these membranes. Jan 01, 2012 one important, wellestablished application is the diagnosis of a pneumothorax. Symptoms typically include sudden onset of sharp, onesided chest pain and shortness of breath. Pneumothorax ptx is an emergency that requires urgent management to avoid catastrophic consequences. Sonographic diagnosis of bilateral pneumothorax following an acupuncture session. 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.
Dec 05, 2019 returning now to the excerpts from sonographic diagnosis of pneumothrorax. Ultrasonography application for detection and management of. Rapid detection of pneumothorax by ultrasonography in patients. Sonographic diagnosis of bilateral pneumothorax following an. 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. Chest radiography cxr is currently the first diagnostic method when clinical examination does not indicate immediate thoracostomy. Sonographic diagnosis of pneumothorax the bedside lung ultrasound diagnostic methodology for pneumothorax has been described in literature. In a pneumothorax, there is air present that separates the visceral and parietal pleura and prevents visualization of the visceral pleura. Anatomical locations of air for rapid diagnosis of. The diagnosis may be apparent to the veterinary physician because the animal exhibits difficulty breathing in, or has shallow breathing. Abstract the ultrasonographic diagnosis of pneumothorax is based on.
Pneumothorax ultrasound radiology reference article. Pdf sonographic diagnosis of a pneumothorax inapparent on. Tension pnx is a very serious condition that can potentially lead to cardiac arrest and requires early diagnosis and urgent treatment. 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. Simultaneous lung point and lung pulse in pneumothorax. Unusual new signs of pneumothorax at lung ultrasound. The lung is usually considered poorly accessible by sonography. The role of chest ultrasonography in the management of. Lung pulse with pneumothorax anesthesiology american.
Sep 02, 2019 bedside diagnostic ultrasound for traumatic pneumothorax is easy and reliable. Prompt and accurate diagnosis of a pneumothorax in the management of a critical patient can prevent the progression into a lifethreatening situation. Dec 19, 20 sonographic diagnosis of pneumothorax the bedside lung ultrasound diagnostic methodology for pneumothorax has been described in literature. 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. Other sonographic signs of pneumothorax besides absence of lung sliding described above. Alternatively, in the setting of high clinical suspicion for pneumothorax and deteriorating respiratory or hemodynamic. Anatomical locations of air for rapid diagnosis of pneumothorax in. Thoracic ultrasound showed barcode sign over left lung figure 1a in m mode and indicated the presence of pneumothorax.
Role of thoracic sonographic scan in diagnosis of pneumothorax. Ultrasonography is being increasingly utilized in acute care settings with expanding applications. The conventional stepbystep sonographic technique and the four conventional ultrasound signs of pneumothorax should be slightly modified. The combination of these two signs, abolition of lung sliding and the simultaneous presence of lines a present 95% sensitivity and 94% specificity lung point is another specific sonographic sign in the diagnosis of pneumothorax. Jan 01, 2008 require urgent diagnosis and immediate management. Thoracic sonography appears to be a promising technique for the exclusion of pneumothorax when chest radiography is delayed. Sonographic detection of pneumothorax by radiology residents as part of extended focused assessment with sonography for trauma. Principles of diagnosis and management of traumatic pneumothorax. Sep 23, 20 introduction ultrasonography is being increasingly utilized in acute care settings with expanding applications. Emergency ultrasound of the chest fulltext respiration 2014. Ultrasound is a modality now available to all physicians and can help in making rapid decisions. Alternatively, in the setting of high clinical suspicion for pneumothorax. Any transmission of this document by any media or format is strictly. Sonographic diagnosis of pneumothorax springerlink.
Sonographic diagnosis of bilateral pneumothorax following an acupuncture session allison harriott md department of emergency medicine, suny downstatekings county hospital center, brooklyn, ny, 11203. If tension pneumothorax suspected in cardiac arrest, treatment. Echocardiography and lung ultrasonography for the assessment. Because of its increasing use in the clinical practice, observations of some unusual and complicated cases are also emerging. Diagnosis of pneumothorax by radiography and ultrasonography. An external file that holds a picture, illustration, etc. Following the cxr computed tomography ct has been the standard for the diagnosis of pneumothorax. Its presence indicates that the parietal and visceral pleura oppose one another, and so its presence rules out a pneumothorax. 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. This suggests that other providers can be trained to quickly perform ultrasonographic scanning and to recognize a suspected pneumothorax with sonography.
Soldati g, testa a, sher s et al 2008 occult traumatic pneumothorax. Pneumothorax evaluation by ultrasonography is a fast, safe, easy and inexpensive alternative to chest radiographs. The rapid and safe diagnosis of pneumothorax, especially in patients with positivepressure ventilation, is important because rapid diagnosis and timely detection can prevent tension pneumothorax. Data from echocardiography and lung ultrasonography can be used to improve diagnostic. The sonographic signs of pneumothorax include the following. Oct 01, 2011 sonographic diagnosis of bilateral pneumothorax following an acupuncture session. 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.
Any information contained in this pdf file is automatically generated from. Firstline sonographic diagnosis of pneumothorax in major. Sonographic diagnosis of a pneumothorax inapparent on. Pneumothorax is a common problem seen in patients with acute and chronic medical and traumatic conditions with wide range of clinical presentations ranging from subtle decrease in breath sounds to cardiopulmonary arrest caused by tension pneumothorax. The sonographic diagnosis of pneumothorax consists in. Pneumothorax isdefined as the presence of air in the pleural. However, in an unstable trauma patient, getting a ct scan is not always possible, and it takes time. Sonographic signs, including lung sliding, blines or comet tail artifacts, alines, and the lung point sign can help in the diagnosis of a pneumothorax.
Ultrasound diagnosis of lung consolidation may be considered as a basic sonographic technique with a steep learning curve 11. Englishlanguage articles on the performance of cr and ultrasonography in the diagnosis of a pneumothorax were selected. When abolishing lung sliding and the aline sign are combined fig. Ouellet jf1, ball cg, panebianco nl, kirkpatrick aw. Cr with transthoracic ultrasonography for the diagnosis of pneumothorax. Artifacts, diagnostic procedure, ultrasound, thorax. In this article we detail the use of sonography for fast and accurate diagnosis of pneumothorax. Article in german wernecke k1, galanski m, peters pe, hansen j. 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.
Vincenthealthandhospitals boardcertifiedemsphysician itsnotjustfor. The sonographic criteria and signs used for pneumothorax diagnosis are defined in the following way. Many of the early references to pneumothorax may have been tension pneumothorax, which can be signi. Pdf role of thoracic sonographic scan in diagnosis of. Sonographic lung sliding accurately rulesout for pneumothorax, but imaging of multiple intercostal spaces in various lung fields is required. Sonographic diagnosis of bilateral pneumothorax following. Oct 04, 2016 sonographic features of pneumothorax dr suresh 1. Use is a simple, reproducible and inexpensive technique that can contribute to the diagnosis of pneumothorax, such as the classic stratosphere or bar code sign in m. A recent consensus process of the main experts in the field has led to the approval of a stepbystep methodology that consists of combining the four main sonographic signs of pneumothorax.
Jul 11, 2016 ct is the gold standard for diagnosis of pneumothorax. Bedside ultrasonography for diagnosis of pneumothorax. Accuracy of transthoracic sonography in detection of. The bilateral, anterior discovery of sliding lung is sufficient to rule out pneumothorax in the vast majority of cases. The lung pulse, described in 2003, 2 is the rhythmic movement of the pleura in synchrony with the cardiac rhythm. Nov 20, 2010 ultrasound diagnosis of pneumothorax relies on the recognition of four sonographic artifact signs. However, the thoracic anatomical locations to be examined are debateable. Chest ultrasonography for the emergency diagnosis of. Pleural ultrasonography versus chest radiography for the. Ultrasonography application for detection and management. Pneumothorax pnx frequently occurs in the ed and icu, especially in patients with trauma and those who are ventilated. Principles of diagnosis and management of traumatic. Ptx is also an important cause of respiratory failure in the emergency department and an annual rate of ptx is estimated at 22.
Bedside diagnostic ultrasound for traumatic pneumothorax is easy and. Lung ultrasound in communityacquired pneumonia and in. Bat sign, lung sliding, pleural line, pneumo thorax, seashore sign, ultrasound. The sonographic appearances of the pleura were studied in 20 normals and in eight patients with radiologically confirmed 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. Mar 01, 2018 a rapid diagnosis of pneumothorax and haemothorax is essential in trauma patients, since chest drainage can be lifesaving. Transthoracic sonography has emerged as a diagnostic tool in various diffuse and focal pulmonary diseases 25 and in pneumothorax and hydropneumothorax 68. Early detection of pneumothorax in multiple trauma patients is critically important. Timely and accurate confirmation or exclusion of ptx is of paramount importance in emergency and critical care. 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%. Ultrasound is a modality now available to all physicians and can help in making rapid decisions, particularly with critically ill patients.
Bedside ultrasonography for diagnosis of pneumothorax chen. Sonography of the lung has been shown to be a useful bedside diagnostic tool in critical care units for pneumothorax pnx. Introduction thoracic sonography is a rapidly evolving imaging modality of choice for lung imaging. Causes of cough, which can be diagnosed by thoracic sonography, are pneumonia, pleural diseases, pneumothorax, pe and, combined with. Accuracy of ultrasound in diagnosis of pneumothorax. 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. Ultrasound diagnosis of pneumothorax relies on the recognition of four sonographic artifact signs. The keywords used in the search strategy were pneumothorax or ultrasound or chest ultrasonography or neonate or adult or aerothorax or sensitivity or specificity. Pdf sonographic diagnosis of a pneumothorax inapparent. Diagnosis of a pneumothorax in the perioperative area can be difficult. Ultrasound diagnosis of pneumothorax after fine needle. The diagnosis of pneumothorax with a bedside lung ultrasound is a.
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