Lung Ultrasound to Detect Pneumothorax in Children Evaluated for Acute Chest Pain in the Emergency Department: An Observational Pilot Study

Abstract

BackgroundSpontaneous pneumothorax is a relatively uncommon and poorly studied condition in children. While several protocols have been developed to evaluate the use of lung ultrasound for dyspneic adult patients in the emergency department, no specific guidelines are present for pediatric emergency physicians.ObjectivesWe prospectively analyzed children with acute chest pain and clinical suspicion of pneumothorax evaluated at the pediatric emergency department.MethodsWe consecutively enrolled children aged 5–17 years presenting to the pediatric emergency department with clinically suspected pneumothorax based on sudden onset of acute chest pain. After clinical examination, all children underwent lung ultrasound followed by chest X-ray (reference standard). We enrolled 77 children, of which 13 (16.9%) received a final diagnosis of pneumothorax.ResultsThe lung point had a sensitivity of 92.3% (95% CI 77.8–100) and a specificity of 100% (95% CI 94.4–100) for the detection of pneumothorax. The “barcode sign” had a sensitivity of 100% (95% CI 75.3–100) and a specificity of 100% (95% CI 94.4–100) for the detection of pneumothorax.ConclusionLung ultrasound is highly accurate in detecting or excluding pneumothorax in children with acute chest pain evaluated in the pediatric emergency department. If pneumothorax is suspected, but the lung point is not visible, the barcode sign should always be sought as it could be a form of massive pneumothorax.

The Role of Lung Ultrasonography as a Diagnostic Tool in Different Pediatric Lung Diseases in Benha University Hospital

“…Scialanga et al (8) revealed the "barcode sign" in 13 patients, and a lung point, indicative of PNX, was present in 12 (92.3%) of the patients. In five (38.5%) patients with a small PNX, Between the anterior axillary and parasternal lines on the anterior chest surface was the lung point.…”

“…In our study, in pneumothorax group, all patients (100%) with pneumothorax had absence of B lines, lung sliding, and lung pulse sign and absent A line, while 37.5% of patients with collapse had lung point sign. Scialanga et al (8) assessed children experiencing acute chest discomfort to determine how accurate LUS was in identifying PNX. Thirty of the seventy-seven children (or 39%) suffered thoracic trauma; twenty of the seventy-seven children (or 26%) had pneumonia, with or without pleural effusions; and thirty of the seventy-seven children (or 39%) had interstitial lung disease, such as viral bronchitis.…”

“…Scialanga et al (8) discovered that the lung point had a 98.4% negative predictive value, a 100% positive predictive value, a 100% specificity, and a 92.3 sensitivity for the detection of PNX. For the identification of PNX, the "barcode sign" had 100% negative predictive value, 100% positive predictive value, 100% specificity, and 100% sensitivity.…”

Spontaneous Pneumomediastinum in a 16-Year-Old Patient with SARS-CoV-2 Infection: A North-East Romanian Case

“…Diagnosis of PMS is generally established by chest X-ray, with chest CT being performed only in complicated cases. Other radiological studies, such as ultrasound, are rarely performed but can help the diagnosis in children [ 17 , 18 ]. Chest CT representative findings in COVID-19 are represented by bilateral ground-glass opacities with or without consolidation involving posterior and peripheral lungs.…”

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department

“…Pulmonary system-related chest pain is also not highly prevalent, accounting for 1.82–12.78% [ 1 , 9 , 12 , 14 , 15 , 16 , 17 , 31 ], with common causes including pneumothorax, asthma, pneumonia, and the less common pneumomediastinum [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Some of these diseases can be potentially life-threatening, such as tension pneumothorax.…”