Lung ultrasound assessment for pneumothorax following transbronchial lung cryobiopsy

Abstract

BackgroundIatrogenic pneumothorax is a common and clinically important transbronchial cryobiopsy (TBCB) complication. A study was conducted to assess the diagnostic accuracy and clinical impact of immediate postprocedure lung ultrasound for diagnosing iatrogenic pneumothorax in patients suspected of interstitial lung disease (ILD) undergoing TBCB.Study design and methodsIn patients undergoing TBCB due to suspected ILD, LUS of the anterior surface of the chest was performed immediately after the TBCB procedure prior to extubation. Presence of lung point was used as a definite sign of pneumothorax. Chest X-ray (CXR) performed routinely 2 h after TBCB was used as reference standard.ResultsA total of 141 consecutive patients were included. Postprocedure LUS identified definite pneumothorax in 5 patients (3.6%)(95%CI: 1.5–8.3%). 2-hour CXR identified 19 patients (13.5%)(95%CI: 8.7–20.2%) with pneumothorax following TBCB. The diagnostic accuracy of LUS for diagnosing pneumothorax was: sensitivity 21.1% (95% CI: 6.1–45.6%), specificity 99.2% (95% CI: 95.5–100.0%), positive predictive value 80.0% (95%CI: 28.4–99.5%), and negative predictive value 89.0% (95%CI: 82.5–93.7%). Postprocedure LUS had a clinical impact in 5 patients (3.6%) (95%CI: 1.5–8.3), in which 4 had pleural drain inserted prior to extubation and 1 patient had prolonged observation prior to extubation.InterpretationLUS performed immediately following TBCB have a clinical impact by identifying patients with pneumothorax in need of immediate treatment prior to extubation, and to monitor pneumothorax size during in the operating room. Supplementary imaging prior to patient discharge is however still needed since the majority of pneumothoraxes develop later in the postprocedure period.

Lung Ultrasound for the Exclusion of Pneumothorax after Interventional Bronchoscopies—A Retrospective Study

“…Another advantage of immediate LUS is its low cost and quick bedside availability. A recent study [ 20 ] found similar results for immediate LUS following TBLC. While the authors also noted low sensitivity for LUS, they described the immediate treatment option and its clinical implications as the main benefit of immediate LUS.…”

“…Recent studies have shown high diagnostic accuracy for post-procedural LUS; immediate LUS after TBFB reached a sensitivity and specificity of 100% [ 4 ], while LUS two hours after TBFB had a sensitivity of 75–100% and a specificity of 83–93% [ 3 , 19 ]. One study [ 20 ] described a sensitivity of 21.1% and a specificity of 99.2% for immediate LUS after TBLC, while another study [ 21 ] had a sensitivity of 90% and a specificity of 94% for LUS 3 h after TBLC.…”

Lung ultrasound in a nutshell. Lines, signs, some applications, and misconceptions from a radiologist’s point of view

“…Clinical correlation is mandatory to not harm the patient. In studies regarding post-biopsy pneumothorax control sensitivity ranges 20-100% [57][58][59], which clearly shows how operator dependent it is and raises the question of the reliable application of the method.…”

Reply to letter to the editor: Conservative management of occult pneumothorax in mechanically ventilated patients—A systematic review and meta-analysis

“…It is also important to note that, in a large pneumothorax, a “lung point” may not be visualized, where no lung is in contact with the pleura 3 . Furthermore, the literature around the use of LUS in quantification of pneumothorax volume appears limited, with one series being in spontaneously ventilated patients and another in patients following lung biopsy 4,5 . Of note, Volpicelli et al 4 note that the best images were obtained over the midaxillary and posterior thorax, and accessing the posterior thorax in ventilated patients can be challenging.…”