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    Thoracic Imaging

    Traumatic Pneumothorax Detection with Thoracic US: Correlation with Chest Radiography and CT—Initial Experience

    Published Online:Oct 1 2002https://doi.org/10.1148/radiol.2251011102

    Abstract

    PURPOSE: To prospectively compare the accuracy of ultrasonography (US) with that of supine chest radiography in the detection of traumatic pneumothoraces, with computed tomography (CT) as the reference standard.

    MATERIALS AND METHODS: Thoracic US, supine chest radiography, and CT were performed to assess for pneumothorax in 27 patients who sustained blunt thoracic trauma. US and radiographic findings were compared with CT findings, the reference standard, for pneumothorax detection. For the purpose of this study, the sonographers were blinded to the radiographic and CT findings.

    RESULTS: Eleven of 27 patients had pneumothorax at CT. All 11 of these pneumothoraces were detected at US, and four were seen at supine chest radiography. In the one false-positive US case, the patient was shown to have substantial bullous emphysema at CT. Sensitivity and negative predictive value of US were 100% (11 of 11 and 15 of 15 patients, respectively), specificity was 94% (15 of 16 patients), and positive predictive value was 92% (11 of 12 patients). Chest radiography had 36% (four of 11 patients) sensitivity, 100% (16 of 16 patients) specificity, a 100% (four of four patients) positive predictive value, and a 70% (16 of 23 patients) negative predictive value.

    CONCLUSION: In this study, US was more sensitive than supine chest radiography and as sensitive as CT in the detection of traumatic pneumothoraces.

    Supplemental material: radiology.rsnajnls.org/cgi/content/full/2251011102/DC1

    © RSNA, 2002

    References

    • 1 Chan O, Hiorns M. Chest trauma. Eur J Radiol 1996; 23:23-34. Crossref, Medline, Google Scholar
    • 2 Tocino IM. Pneumothorax in the supine patient. RadioGraphics 1985; 5:557-586. Link, Google Scholar
    • 3 Goodman TR, Traill ZC, Phillips AJ, Berger J, Gleeson FV. Ultrasound detection of pneumothorax. Clin Radiol 1999; 54:736-739. Crossref, Medline, Google Scholar
    • 4 Wall SD, Federle MP, Jeffrey RB, Brett CM. CT diagnosis of unsuspected pneumothorax after blunt abdominal trauma. AJR Am J Roentgenol 1983; 141:919-921. Crossref, Medline, Google Scholar
    • 5 Boulanger BR, Rozycki GS, Rodriguez A. Sonographic assessment of traumatic injury: future developments. Surg Clin North Am 1999; 79:1297-1316. Crossref, Medline, Google Scholar
    • 6 Scalea TM, Rodriguez A, Chiu W, et al. Focused assessment with sonography for trauma (FAST): results from an international consensus conference. J Trauma 1999; 46:466-472. Crossref, Medline, Google Scholar
    • 7 Lichtenstein D, Meziere G, Biderman P, Gepner A. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 1999; 25:383-388. Crossref, Medline, Google Scholar
    • 8 Wernecke K, Galanski M, Peters PE, Hansen J. Pneumothorax: evaluation by ultrasound—preliminary results. J Thorac Imaging 1987; 2:76-78. Medline, Google Scholar
    • 9 Sistrom CL, Reiheld CT, Gay SB, Wallace KK. Detection and estimation of the volume of pneumothorax using real-time sonography: efficacy determined by receiver operating characteristic analysis. AJR Am J Roentgenol 1996; 166:317-321. Crossref, Medline, Google Scholar
    • 10 Lichenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill: lung sliding. Chest 1995; 108:1345-1348. Crossref, Medline, Google Scholar
    • 11 Targhetta R, Bourgeois JM, Chavagneux R, Balmes P. Diagnosis of pneumothorax by ultrasound immediately after ultrasonically guided aspiration biopsy. Chest 1992; 101:855-856. Crossref, Medline, Google Scholar
    • 12 Dulchavsky SA, Schwarz KL, Kirkpatrick AW, et al. Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. J Trauma 2001; 50:201-205. Crossref, Medline, Google Scholar
    • 13 Simons R. Vancouver General Hospital trauma program manual 4th ed. Vancouver, British Columbia, Canada: Vancouver General Hospital, 1999. Google Scholar
    • 14 Esposito TJ, Jurkovich GJ, Rice CL, Maier RV, Copass MK, Ashbaugh DG. Reappraisal of emergency room thoracotomy in a changing environment. J Trauma 1991; 31:881-887. Crossref, Medline, Google Scholar
    • 15 Baumann MH, Sahn SA. Tension pneumothorax: diagnostic and therapeutic pitfalls. Crit Care Med 1993; 21:177-179. Crossref, Medline, Google Scholar
    • 16 Tocino IM, Westcott JL. Barotrauma. Radiol Clin North Am 1996; 34:59-81. Medline, Google Scholar
    • 17 Dulchavsky SA, Hamilton DR, Diebel LN, Sargsyan AE, Billica RD, Williams DR. Thoracic ultrasound diagnosis of pneumothorax. J Trauma 1999; 47:970-971. Crossref, Medline, Google Scholar
    • 18 Kirkpatric AW, Ng A, Dulchavsky SA, et al. Sonographic diagnosis of a pneumothorax inapparent on plain radiography: confirmation by computed tomography. J Trauma 2001; 50:750-752. Crossref, Medline, Google Scholar
    • 19 Sargsyan AE, Hamilton DR, Nicolaou S, et al. Ultrasound evaluation of the magnitude of pneumothorax: a new concept. Am Surg 2001; 67:232-236. Medline, Google Scholar

    Article History

    Published in print: Oct 2002