Occult Pneumothorax Identification on Extended Focused Assessment with Sonography for Trauma Examination in Children

Abstract

Objective: Occult pneumothoraces (OPTXs) are defined by air within the pleural space that is not visible on conventional chest radiographs (CXR). The aim of this study was to understand how frequently the Extended Focused Assessment with Sonography for Trauma (eFAST) examination identifies occult PTX in a pediatric blunt trauma population as compared with a criterion standard of chest computed tomography (CCT).Methods: This study is a secondary analysis of blunt trauma patients younger than 18 years who underwent CCT at Los Angeles County +USC Medical Center Emergency Department from October 2015 to April 2017. The eFASTexamination was performed and documented by an emergency medicine resident with attending oversight or by an emergency medicine attending for each trauma. The eFAST results were reviewed for patients diagnosed with small or trace pneumothoraces identified on CCT.Results: Of 168 pediatric trauma patients undergoing CCT, 16 had OPTXs not seen on CXR and 4 patients had a small/trace PTX without a corresponding CXR performed. None were identified on eFAST.Conclusions: Although the sample size in this data set was small, our eFASTexaminations identified none of 16 proven and 4 presumed OPTXs. The standard eFAST examination performed poorly in the detection of OPTXs in this single-center study of pediatric blunt trauma victims.

Precordial Heart Image Disappearance: An Uncommon New Specific Ultrasound Sign for Diagnosing Neonatal Pneumothorax and its Thoracentesis Treatment at the Precardiac Area- an Pilot Study Reports from Two Centers

“…PTX is traditionally diagnosed by chest X-ray or computed tomography (CT),both in adults and children [5][6][7].However,there is a certain missed diagnosis rate in radiological diagnosis,especially for occult PTX [8].Moreover,there is inevitable radiation damage associated with CT.Radiation damage is particularly severe for growing newborns and premature babies.Recently,lung ultrasonography (LUS) has been successfully used to diagnose PTX.Clinical studies and literatures have proved that the sensitivity and speci city of LUS in the diagnosis of PTX,both in adults and children, are superior to X-ray [9][10][11].…”