A Study on the Evaluation of Pneumothorax by Imaging Methods in Patients Presenting to Emergency Department for Blunt Thoracic Trauma

Abstract

BACKGROUND: Pneumothorax (PNX) is the collection of air between parietal and visceral pleura, and collapsed lung develops as a complication of the trapped air. PNX is likely to develop spontaneously in people with risk factors. However, it is mostly seen with blunt or penetrating trauma. Diagnosis is generally confirmed by chest radiography [posteroanterior chest radiography (PACR)]. Chest ultrasound (US) is also a promising technique for the detection of PNX in trauma patients. There is not much literature on the evaluation of blunt thoracic trauma (BTT) and pneumothorax (PNX) in the emergency department (ED). The aim of this study was to investigate the effectiveness of chest US for the diagnosis of PNX in patients presenting to ED with BTT

Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital

“…(10) In a single-blind prospective clinical study, chest ultrasonography was more reliable for early bedside diagnosis of pneumothorax compared with supine chest radiography. (11) Langdrof et al have shown, in a multicentre prospective study, that 71% of chest injuries would be missed if chest radiography was done without chest CT for occult injuries and that 14% of these occult injuries would need major interventions, including chest tube insertion for haemothorax or pneumothorax, mechanical ventilation or surgery. (2) CT is more sensitive and specific when compared to chest radiography and significantly reduces the time for patient management in emergency departments.…”

Value of point-of-care ultrasonography compared with computed tomography scan in detecting potential life-threatening conditions in blunt chest trauma patients

“…Some researchers described cases with clinically significant pneumothorax who were not diagnosed by chest ultrasonography due to the uneven distribution of pneumothorax in the pleural cavity with pulmonary adhesions to the chest wall with or without lung contusion. Moreover, "double lung point sign" as reported, may under or overestimate the PTX size by ultrasonography [4,7,19]. The extent of PTX was estimated by Blaivas et al assessing the pleural sliding in several intercostal spaces and identified fair correlation with CT scan findings.…”

“…They also evaluated pleural sliding by standard scan areas of “Power Doppler” to detect the fine pleural shimmering that may be difficult to detect due to resolution limitations [ 20 , 21 ]. Some suggested differential diagnoses of dyspnea account for the most false-positive pneumothoraces in intensive care units including lung cancer, significant pulmonary infiltration or contusion, pleural or pulmonary adhesions and thoracic surgery, and in other settings such as achalasia [ 7 , 22 ], many of which are grouped in Table 4 .…”

“…Subsequently, the low-frequency probe was positioned in the 5th to 6th right anterior to mid-axillary region and 7th to 8th left mid to posterior axillary region to find hemothorax as part of the eFAST exam [ 7 ]. Each bedside scan was performed routinely in 3–5 min.…”

“…Each lung was scanned at least in 4 spaces for the evidence of pneumothorax, hemothorax and lung contusion by B and M modes: the probe was placed in the 2nd to 4th intercostal spaces in midclavicular and parasternal lines and the 6th or 7th intercostal space in the mid-axillary line in the supine position. Subsequently, the low-frequency probe was positioned in the 5th to 6th right anterior to mid-axillary region and 7th to 8th left mid to posterior axillary region to find hemothorax as part of the eFAST exam [7]. Each bedside scan was performed routinely in 3-5 min.…”