Role of Thoracic Sonographic Scan in Diagnosis of Pneumothorax
Affiliation(s)
1 Department of Surgery, Faculty of Medical Sciences, School of Medicine, University of Sulaimani, Sulaymaniyah, Iraqi Kurdistan. 2 Department of Thoracic and Cardiovascular Surgery, Sulaimani Teaching Hospital, Sulaymaniyah, Iraqi Kurdistan. 3 Sulaimani DOH, Sulaimani Teaching Hospital, Sulaymaniyah, Iraq Kurdistan.
1 Department of Surgery, Faculty of Medical Sciences, School of Medicine, University of Sulaimani, Sulaymaniyah, Iraqi Kurdistan. 2 Department of Thoracic and Cardiovascular Surgery, Sulaimani Teaching Hospital, Sulaymaniyah, Iraqi Kurdistan. 3 Sulaimani DOH, Sulaimani Teaching Hospital, Sulaymaniyah, Iraq Kurdistan.
ABSTRACT
Background: 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. Pneumothorax is traditionally diagnosed by chest radiography, ultrasound is fairly a new modality of diagnosis. Ultrasound is a rapid noninvasive bedside test that may reduce mortality from this pathology by early detection. There are certain sonographic criteria that can exclude or confirm pneumothorax; this work has been performed to analyze these criteria. Patients and Methods: The study was done in Sulaimani teaching hospital and Sulaimani emergency hospital from June 1st to 10th August 2013. We performed thoracic ultrasound on fifty three diagnosed cases of pneumothorax (by chest X-ray &/or thoracic computed tomography). The age of the patients ranged between (10 - 82 years), mean age (38 years), 35 males and 18 females. Lung sliding sign, lung point sign and A line signs were recorded and analyzed. Results: The sensitivity, specificity, positive predictive value and negative predictive values of absent lung sliding sign were: 100%, 94%, 94% and 100% respectively, for lung point sign were: 70%, 100%, 100% and 68% respectively, for A line sign were: 91%, 71%, 73% and 91% respectively, for absent lung sliding and lung point sign together were 70%, 100%, 100% & 68.9% respectively. Conclusion: We confirmed the conclusion of other studies which stated that presence of lung sliding excludes pneumothorax and identification of lung point in a case with absent lung sliding is diagnostic of pneumothorax.
Background: 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. Pneumothorax is traditionally diagnosed by chest radiography, ultrasound is fairly a new modality of diagnosis. Ultrasound is a rapid noninvasive bedside test that may reduce mortality from this pathology by early detection. There are certain sonographic criteria that can exclude or confirm pneumothorax; this work has been performed to analyze these criteria. Patients and Methods: The study was done in Sulaimani teaching hospital and Sulaimani emergency hospital from June 1st to 10th August 2013. We performed thoracic ultrasound on fifty three diagnosed cases of pneumothorax (by chest X-ray &/or thoracic computed tomography). The age of the patients ranged between (10 - 82 years), mean age (38 years), 35 males and 18 females. Lung sliding sign, lung point sign and A line signs were recorded and analyzed. Results: The sensitivity, specificity, positive predictive value and negative predictive values of absent lung sliding sign were: 100%, 94%, 94% and 100% respectively, for lung point sign were: 70%, 100%, 100% and 68% respectively, for A line sign were: 91%, 71%, 73% and 91% respectively, for absent lung sliding and lung point sign together were 70%, 100%, 100% & 68.9% respectively. Conclusion: We confirmed the conclusion of other studies which stated that presence of lung sliding excludes pneumothorax and identification of lung point in a case with absent lung sliding is diagnostic of pneumothorax.
Cite this paper
Mahmood, K. , Baram, A. , H. Kakamad, F. and Ahmed, K. (2015) Role of Thoracic Sonographic Scan in Diagnosis of Pneumothorax. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 4, 255-262. doi: 10.4236/ijmpcero.2015.43030.
Mahmood, K. , Baram, A. , H. Kakamad, F. and Ahmed, K. (2015) Role of Thoracic Sonographic Scan in Diagnosis of Pneumothorax. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 4, 255-262. doi: 10.4236/ijmpcero.2015.43030.
References
[1] Noppen, M. and De Keukeleire, T. (2008) Pneumothorax. Respiration, 76, 121-127.
http://dx.doi.org/10.1159/000135932 [2] Knudtson, J.L., Dort, J.M., Helmer, S.D. and Smith, R.S. (2004) Surgeon-Performed Ultrasound for Pneumothorax in the Trauma Suite. Journal of Trauma, 56, 527-530.
http://dx.doi.org/10.1097/01.TA.0000114529.99353.22 [3] Husain, L.F. and Hagopian, L. (2012) Sonographic Diagnosis of Pneumothorax. Journal of Emergencies, Trauma, and Shock, 5, 76-81.
http://dx.doi.org/10.4103/0974-2700.93116 [4] Monti, J.D., Younggren, B. and Blankenship, R. (2009) Ultrasound Detection of Pneumothorax with Minimally Trained Sonographers: A Preliminary Study. Journal of Special Operations Medicine, 9, 43-46. [5] Lichtenstein, D.A., Meziere, G., Lascols, N., Biderman, P., Courret, J.P., Gepner, A., et al. (2005) Ultrasound Diagnosis of Occult Pneumothorax. Critical Care Medicine, 33, 1231-1238.
http://dx.doi.org/10.1097/01.CCM.0000164542.86954.B4 [6] Tocino, I.M., Miller, M.H. and Fairfax, W.R. (1985) Distribution of Pneumothorax in the Supine and Semirecumbent Critically Ill Adult. American Journal of Roentgenology, 144, 901-905.
http://dx.doi.org/10.2214/ajr.144.5.901 [7] Ball, C.G., Kirkpatrick, A.W., Laupland, K.B., Fox, D.L., Litvinchuk, S., Dyer, D.M., et al. (2005) Factors Related to the Failure of Radiographic Recognition of Occult Posttraumatic Pneumothoraces. The American Journal of Surgery, 189, 541-546.
http://dx.doi.org/10.1016/j.amjsurg.2005.01.018 [8] Weissberg, D. and Refaely, Y. (2000) Pneumothorax: Experience with 1,199 Patients .Chest, 117, 1279-1285.
http://dx.doi.org/10.1378/chest.117.5.1279 [9] De Luca, C., Valentino, M., Rimondi, M., Branchini, M., Baleni, M.C. and Barozzi, L. (2008) Use of Chest Sonography in Acute-Care Radiology. Journal of Ultrasound, 11, 125-134.
http://dx.doi.org/10.1016/j.jus.2008.09.006 [10] Barillari, A. and Kiuru, S. (2010) Detection of Spontaneous Pneumothorax with Chest Ultrasound in the Emergency Department. Internal and Emergency Medicine, 5, 253-255.
http://dx.doi.org/10.1007/s11739-010-0347-z [11] Dulchavsky, S.A., Schwarz, K.L., Kirkpatrick, A.W., Billica, R.D., Williams, D.R., Diebel, L.N., et al. (2001) Prospective Evaluation of Thoracic Ultrasound in the Detection of Pneumothorax. Journal of Trauma, 50, 201-205.
http://dx.doi.org/10.1097/00005373-200102000-00003 [12] Johnson, A. (2009) Emergency Department Diagnosis of Pneumothorax Using Goal-Directed Ultrasound. Academic Emergency Medicine, 16, 1379-1380.
http://dx.doi.org/10.1111/j.1553-2712.2009.00542.x [13] Murphy, M., Nagdev, A. and Sisson, C. (2008) Lack of Lung Sliding on Ultrasound Does Not Always Indicate a Pneumothorax. Resuscitation, 77, 270.
http://dx.doi.org/10.1016/j.resuscitation.2007.10.026 [14] Blaivas, M., Lyon, M. and Duggal, S. (2005) A Prospective Comparison of Supine Chest Radiography and Bedside Ultrasound for the Diagnosis of Traumatic Pneumothorax. Academic Emergency Medicine, 12, 844-849.
http://dx.doi.org/10.1111/j.1553-2712.2005.tb00960.x [15] Ball, C.G., Kirkpatrick, A.W. and Feliciano, D.V. (2009) The Occult Pneumothorax: What Have We Learned? Canadian Journal of Surgery, 52, E173-E179. [16] Lichtenstein, D., Meziere, G., Biderman, P. and Gepner, A. (2000) The “Lung Point”: An Ultrasound Sign Specific to Pneumothorax. Intensive Care Medicine, 26, 1434-1440.
http://dx.doi.org/10.1007/s001340000627 [17] Kirkpatrick, A.W., Sirois, M., Laupland, K.B., Liu, D., Rowan, K., Ball, C.G., et al. (2004) Hand-Held Thoracic Sonography for Detecting Post-Traumatic Pneumothoraces: The Extended Focused Assessment with Sonography for Trauma (EFAST). Journal of Trauma, 57, 288-295.
http://dx.doi.org/10.1097/01.TA.0000133565.88871.E4 [18] Lichtenstein, D.A. and Menu, Y.A. (1995) Bedside Ultrasound Sign Ruling out Pneumothorax in the Critically III: Lung Sliding. Chest, 108, 1345-1348.
http://dx.doi.org/10.1378/chest.108.5.1345 [19] Soldati, G., Testa, A., Sher, S., Pignataro, G., La Sala, M. and Silveri, N.G. (2008) Occult Traumatic Pneumothorax: Diagnostic Accuracy of Lung Ultrasonography in the Emergency Department. Chest, 133, 204-211.
http://dx.doi.org/10.1378/chest.07-1595 [20] Gobien, R.P., Reines, H.D. and Schabel, S.I. (1982) Localizedtension Pneumothorax: Unrecognized Form of Barotrauma in ARDS. Radiology, 142, 15-19.
http://dx.doi.org/10.1148/radiology.142.1.7031759 [21] Rowan, K.R. and Kirkpatrick, A.W. (2002) Traumatic Pneumothorax Detection with Thoracic US: Correlation with Chest Radiography and CT—Initial Experience. Radiology, 225, 210-214.
http://dx.doi.org/10.1148/radiol.2251011102 [22] Reissig, A. and Kroegel, C. (2000) Transthoracic Sonography: Principles and Applications. Thieme, New York.
[1] Noppen, M. and De Keukeleire, T. (2008) Pneumothorax. Respiration, 76, 121-127.
http://dx.doi.org/10.1159/000135932 [2] Knudtson, J.L., Dort, J.M., Helmer, S.D. and Smith, R.S. (2004) Surgeon-Performed Ultrasound for Pneumothorax in the Trauma Suite. Journal of Trauma, 56, 527-530.
http://dx.doi.org/10.1097/01.TA.0000114529.99353.22 [3] Husain, L.F. and Hagopian, L. (2012) Sonographic Diagnosis of Pneumothorax. Journal of Emergencies, Trauma, and Shock, 5, 76-81.
http://dx.doi.org/10.4103/0974-2700.93116 [4] Monti, J.D., Younggren, B. and Blankenship, R. (2009) Ultrasound Detection of Pneumothorax with Minimally Trained Sonographers: A Preliminary Study. Journal of Special Operations Medicine, 9, 43-46. [5] Lichtenstein, D.A., Meziere, G., Lascols, N., Biderman, P., Courret, J.P., Gepner, A., et al. (2005) Ultrasound Diagnosis of Occult Pneumothorax. Critical Care Medicine, 33, 1231-1238.
http://dx.doi.org/10.1097/01.CCM.0000164542.86954.B4 [6] Tocino, I.M., Miller, M.H. and Fairfax, W.R. (1985) Distribution of Pneumothorax in the Supine and Semirecumbent Critically Ill Adult. American Journal of Roentgenology, 144, 901-905.
http://dx.doi.org/10.2214/ajr.144.5.901 [7] Ball, C.G., Kirkpatrick, A.W., Laupland, K.B., Fox, D.L., Litvinchuk, S., Dyer, D.M., et al. (2005) Factors Related to the Failure of Radiographic Recognition of Occult Posttraumatic Pneumothoraces. The American Journal of Surgery, 189, 541-546.
http://dx.doi.org/10.1016/j.amjsurg.2005.01.018 [8] Weissberg, D. and Refaely, Y. (2000) Pneumothorax: Experience with 1,199 Patients .Chest, 117, 1279-1285.
http://dx.doi.org/10.1378/chest.117.5.1279 [9] De Luca, C., Valentino, M., Rimondi, M., Branchini, M., Baleni, M.C. and Barozzi, L. (2008) Use of Chest Sonography in Acute-Care Radiology. Journal of Ultrasound, 11, 125-134.
http://dx.doi.org/10.1016/j.jus.2008.09.006 [10] Barillari, A. and Kiuru, S. (2010) Detection of Spontaneous Pneumothorax with Chest Ultrasound in the Emergency Department. Internal and Emergency Medicine, 5, 253-255.
http://dx.doi.org/10.1007/s11739-010-0347-z [11] Dulchavsky, S.A., Schwarz, K.L., Kirkpatrick, A.W., Billica, R.D., Williams, D.R., Diebel, L.N., et al. (2001) Prospective Evaluation of Thoracic Ultrasound in the Detection of Pneumothorax. Journal of Trauma, 50, 201-205.
http://dx.doi.org/10.1097/00005373-200102000-00003 [12] Johnson, A. (2009) Emergency Department Diagnosis of Pneumothorax Using Goal-Directed Ultrasound. Academic Emergency Medicine, 16, 1379-1380.
http://dx.doi.org/10.1111/j.1553-2712.2009.00542.x [13] Murphy, M., Nagdev, A. and Sisson, C. (2008) Lack of Lung Sliding on Ultrasound Does Not Always Indicate a Pneumothorax. Resuscitation, 77, 270.
http://dx.doi.org/10.1016/j.resuscitation.2007.10.026 [14] Blaivas, M., Lyon, M. and Duggal, S. (2005) A Prospective Comparison of Supine Chest Radiography and Bedside Ultrasound for the Diagnosis of Traumatic Pneumothorax. Academic Emergency Medicine, 12, 844-849.
http://dx.doi.org/10.1111/j.1553-2712.2005.tb00960.x [15] Ball, C.G., Kirkpatrick, A.W. and Feliciano, D.V. (2009) The Occult Pneumothorax: What Have We Learned? Canadian Journal of Surgery, 52, E173-E179. [16] Lichtenstein, D., Meziere, G., Biderman, P. and Gepner, A. (2000) The “Lung Point”: An Ultrasound Sign Specific to Pneumothorax. Intensive Care Medicine, 26, 1434-1440.
http://dx.doi.org/10.1007/s001340000627 [17] Kirkpatrick, A.W., Sirois, M., Laupland, K.B., Liu, D., Rowan, K., Ball, C.G., et al. (2004) Hand-Held Thoracic Sonography for Detecting Post-Traumatic Pneumothoraces: The Extended Focused Assessment with Sonography for Trauma (EFAST). Journal of Trauma, 57, 288-295.
http://dx.doi.org/10.1097/01.TA.0000133565.88871.E4 [18] Lichtenstein, D.A. and Menu, Y.A. (1995) Bedside Ultrasound Sign Ruling out Pneumothorax in the Critically III: Lung Sliding. Chest, 108, 1345-1348.
http://dx.doi.org/10.1378/chest.108.5.1345 [19] Soldati, G., Testa, A., Sher, S., Pignataro, G., La Sala, M. and Silveri, N.G. (2008) Occult Traumatic Pneumothorax: Diagnostic Accuracy of Lung Ultrasonography in the Emergency Department. Chest, 133, 204-211.
http://dx.doi.org/10.1378/chest.07-1595 [20] Gobien, R.P., Reines, H.D. and Schabel, S.I. (1982) Localizedtension Pneumothorax: Unrecognized Form of Barotrauma in ARDS. Radiology, 142, 15-19.
http://dx.doi.org/10.1148/radiology.142.1.7031759 [21] Rowan, K.R. and Kirkpatrick, A.W. (2002) Traumatic Pneumothorax Detection with Thoracic US: Correlation with Chest Radiography and CT—Initial Experience. Radiology, 225, 210-214.
http://dx.doi.org/10.1148/radiol.2251011102 [22] Reissig, A. and Kroegel, C. (2000) Transthoracic Sonography: Principles and Applications. Thieme, New York.