Limited Chest Ultrasound to Replace CXR in Diagnosis of Pneumothorax Post Image-Guided Transthoracic Interventions

Abstract

Purpose: To assess the diagnostic accuracy of limited chest ultrasound in detecting pneumothorax following percutaneous transthoracic needle interventions using chest X-ray (CXR) as the reference standard. Methods: With IRB approval, after providing consent, asymptomatic patients after percutaneous transthoracic needle interventions were enrolled to undergo limited chest ultrasound in addition to CXR. A chest Radiologist blinded to the patient’s prior imaging performed a bedside ultrasound, scanning only the first 3 anterior intercostal spaces. Pneumothorax diagnosed on CXR was categorized as small or large and on ultrasound as grades 1, 2, or 3 when detected in 1, 2, or 3 intercostal spaces, respectively. Results: 38 patients underwent 36 biopsies (34 lungs, 1 pleura, and 1 mediastinum) and 2 coil localizations. CXR showed pneumothorax in 13 patients. Ultrasound was positive in 10 patients, with 9 true-positives, 1 false-positive, 4 false-negatives, and 24 true-negatives. The false positive results were due to apical subpleural bullae. The false-negative results occurred in 2 small apical and 2 focal pneumothoraces at the needle entry sites. Four pneumothoraces were categorized as large on CXR, all of which were categorized as grade 3 on ultrasound. Sensitivity and specificity of US for detection of pneumothorax of any size were 69.23% (95%CI 38.6%, 90.1%) and 96.0% (95%CI 79.6%, 99.9%), and for detection of large pneumothorax were 100% (95%CI 39.8%, 100%) and 100% (95%CI 89.7%, 100%). Conclusions: Results of this prospective study is promising. Limited chest ultrasound could potentially replace CXR in the management of postpercutaneous transthoracic needle intervention patients.

Diagnostic performance of lung ultrasound in detecting pneumothorax after CT- Guided transthoracic biopsy

“…detecting large PTX. 19 In our study, thanks to the gold standard of CT in the lung window, we could measure precisely the size and classify PTX.…”

The Lung Point: An Ultrasound Finding in the Diagnosis and Semi-Quantification of Pneumothorax After Ct-Guided Transthoracic Biopsy

“…Our study's data showed that the LP location had significantly high sensitivity and specificity in the semiquantification of PTX. [7]. In our study, thanks to the gold standard of CT in the lung window, we could measure precisely the size and classify PTX.…”

“…LP is one of the most outweighed the other LUS findings because it has evaluability in diagnosing and predicting the size of PTX. [6,7] Nevertheless, LUS is a new issue in Vietnam, not yet widely used in clinical practice and research.…”

Humán kadávermodell a légmell ágy melletti ultrahang-diagnosztikájához.

“…A konvencionális -döntően fizikális és egyszerű eszközzel végzett -vizsgálatokon alapuló diagnosztikát az elmúlt másfél évtizedben méltán egészíti ki az ágy melletti ultrahangvizsgálat, melynek specificitása és szenzitivitása alkalmassá teszi a módszert arra, hogy az "első vonalban" része lehessen a vizsgálati protokolloknak [9][10][11][12][13]. Korábbi, humán kadávereken végzett tanulmányok tapasztalatai azt mutatják, hogy ezek a modellek kiválóan EREDETI KÖZLEMÉNY alkalmasak az ultrahangalapú légmell-diagnosztika elsajátítására [2,3].…”

“…Alkalmazhatósága és a légmell diagnosztikájában mutatkozó szenzitivitása és specificitása ma már gyakorlatilag nem tárgya szakmai vitáknak [9][10][11][12][13]. Tény azonban, hogy a tüdő ultrahangos képalkotása a konvencionális radiológiai elképzelésektől eltérő logikát kíván.…”