Citation Information :
Bhoil R, Kumar R, Kaur J, Attri PK, Thakur R. Diagnosis of Traumatic Pneumothorax: A Comparison between Lung Ultrasound and Supine Chest Radiographs. Indian J Crit Care Med 2021; 25 (2):176-180.
Background/Objective: Traumatic pneumothorax is an ominous condition necessitating urgent appropriate action. It is typically detected on chest X-rays; however, these may not be able to detect the presence of a subtle pneumothorax, especially in supine position. Lung ultrasound is emerging as a promising modality for detecting pneumothorax in trauma patients. The aim of our study was to compare ultrasound with supine chest radiography for the detection of pneumothorax in trauma patients. Materials and Methods: This was a prospective, single-blinded study carried out on 212 adult thoracoabdominal trauma patients who underwent ultrasound FAST and supine (AP) chest radiography. During the FAST sonography, ultrasound thorax was done to rule out pneumothorax. Only those cases were considered (118) in which the presence or absence of pneumothorax could be confirmed on CT done subsequently or where pneumothorax was confirmed by air escape on chest tube placement, wherever indicated, and the results were compared with sonographic and chest X-ray findings. Observation/Results: There were 48 true positives on CT/chest tube insertion. Among these, ultrasound was able to correctly detect pneumothorax in 43 patients, while supine chest X-rays correctly identified 33 cases. Sensitivity of ultrasound was 89.6 vs. 68.8% of supine chest radiography. Lung ultrasound also had a higher negative predictive value as compared to supine chest X-rays. Conclusions: Lung ultrasound is more sensitive in detecting traumatic pneumothorax than supine chest X-rays, in addition to having numerous other inherent advantages over chest radiography. It should be incorporated in the emergency assessment of thoracic trauma patients to rule out pneumothorax. Clinical significance: Lung sonography is more sensitive in detecting traumatic pneumothorax than supine chest X-rays. No added equipment is required, and the procedure can be carried out at the time of doing ultrasound FAST, thus saving precious time in trauma patients.
Hefny AF, Kunhivalappil FT, Matev N, Avila NA, Bashir MO, Abu-Zidan FM. Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital. Singapore Med J 2018;59(3):150–154. DOI: 10.11622/smedj.2017074.
Zarogoulidis P, Kioumis I, Pitsiou G, Porpodis K, Lampaki S, Papaiwannou A, et al. Pneumothorax: from definition to diagnosis and treatment. J Thorac Dis 2014;6(Suppl. 4):S372–S376. DOI: 10.3978/j.issn.2072-1439.2014.09.24.
Kaneda H, Nakano T, Taniguchi Y, Saito T, Konobu T, Saito Y. Three-step management of pneumothorax: time for a re-think on initial management. Interact Cardiovasc Thorac Surg 2013;16(2):186–192. DOI: 10.1093/icvts/ivs445.
Ince A, Ozucelik DN, Avci A, Nizam O, Dogan H, Topal MA. Management of pneumothorax in emergency medicine departments: multicenter trial. Iran Red Crescent Med J 2013;15(12):e11586. DOI: 10.5812/ircmj.11586.
Ball CG, Kirkpatrick AW, Laupland KB, Fox DL, Litvinchuk S, Dyer DM, et al. Factors related to the failure of radiographic recognition of occult posttraumatic pneumothoraces. Am J Surg 2005;189(5):541–546. DOI: 10.1016/j.amjsurg.2005.01.018.
Lewis FR, Blaisdell FW, Schlobohm RM. Incidence and outcome of posttraumatic respiratory failure. Arch Surg 1977;112(4):436–443. DOI: 10.1001/archsurg.1977.01370040088014.
Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with sonography for trauma (EFAST). J Trauma 2004;57(2):288–295. DOI: 10.1097/01.ta.0000133565.88871.e4.
Ebrahimi A, Yousefifard M, Mohammad Kazemi H, Rasouli HR, Asady H, Moghadas Jafari A, et al. Diagnostic accuracy of chest ultrasonography versus chest radiography for identification of pneumothorax: a systematic review and meta-analysis. Tanaffos 2014;13(4):29–40.
Nagarsheth K, Kurek S. Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan. Am Surg 2011;77(4):480–484.
Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med 2010;17(1):11–17. DOI: 10.1111/j.1553-2712.2009.00628.x.
Ding W, Shen Y, Yang J, He X, Zhang M. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest 2011;140(4):859–866. DOI: 10.1378/chest.10-2946.
Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med 2005;12(9):844–849. DOI: 10.1197/j.aem.2005.05.005.
Chaudhry R, Galagali A, Narayanan RV. Focused abdominal sonography in trauma (FAST). Med J Armed Forces India 2007;63(1): 62–63. DOI: 10.1016/S0377-1237(07)80113-4.
Lee FC. Lung ultrasound—a primary survey of the acutely dyspneic patient. J Intensive Care 2016;4(1):57. DOI: 10.1186/s40560-016-0180-1.
Saraogi A. Lung ultrasound: present and future. Lung India 2015;32(3):250–257. DOI: 10.4103/0970-2113.156245.
Lichtenstein D. Novel approaches to ultrasonography of the lung and pleural space: where are we now? Breathe (Sheff) 2017;13(2):100–111. DOI: 10.1183/20734735.004717.
Abdalla W, Elgendy M, Abdelaziz AA, Ammar MA. Lung ultrasound versus chest radiography for the diagnosis of pneumothorax in critically ill patients: a prospective, single-blind study. Saudi J Anaesth 2016;10(3):265–269. DOI: 10.4103/1658-354X.174906.