Pneumothorax and the value of chest radiography after ultrasound-guided thoracocentesis

Pihlajamaa, Kai; Bode, Michaela K.; Puumalainen, Tanja; Lehtimäki, Antti; Marjelund, S.; Tikkakoski, Tapani

doi:10.1080/02841850410008270

Cited by 26 publications

(29 citation statements)

References 12 publications

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“…The literature [215,220,224,232,233,246,247] confirms that a vast majority of post-interventional pneumothoraxes could be proven within 4 h by symptoms or imaging procedures. Accordingly, the risk of later-onset pneumothorax is slight.…”

Section: Evidence Gradementioning

confidence: 79%

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Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

et al. 2018

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In Germany, 10,000 cases of spontaneous pneumothorax are treated inpatient every year. The German Society for Thoracic Surgery, in co-operation with the German Society for Pulmonology, the German Radiological Society, and the German Society of Internal Medicine has developed an S3 guideline on spontaneous pneumothorax and post-interventional pneumothorax moderated by the German Association of Scientific Medical Societies. Method: Based on the source guideline of the British Thoracic Society (2010) for spontaneous pneumothorax, a literature search on spontaneous pneumothorax was carried out from 2008 onwards, for post-interventional pneumothorax from 1960 onwards. Evidence levels according to the Oxford Center for Evidence-Based Medicine (2011) were assigned to the relevant studies found. Recommendations according to grade (A: “we recommend”/“we do not recommend,” B: “we suggest”/“we do not suggest”) were determined in 3 consensus conferences by the nominal group process. Results: The algorithms for primary and secondary pneumothorax differ in the indication for CT scan as well as in the indication for chest drainage application and video-assisted thoracic surgery. Indication for surgery is recommended individually taking into account the risk of recurrence, life circumstances, patient preferences, and procedure risks. For some forms of secondary pneumothorax, a reserved indication for surgery is recommended. Therapy of post-interventional spontaneous pneumothorax is similar to that of primary spontaneous pneumothorax. Discussion: The recommendations of the S3 Guideline provide assistance in managing spontaneous pneumothorax and post-interventional pneumothorax. Whether this will affect existing deviant diagnostic and therapeutic measures will be demonstrated by future epidemiological studies.

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Section: Evidence Gradementioning

confidence: 79%

“…Literature: de Novo Research: Choi et al [215], Kim et al [220], Doyle et al [232], Pihlajamaa et al [233] Consensus rate: 100%…”

Section: Evidence Gradementioning

confidence: 99%

Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

et al. 2018

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“…In contrast, the pneumothorax rate associated with ultrasound-guided thoracenteses was lower, ranging from 0 to 9.1%. The rates of subsequent chest tube insertion for pneumothoraces ranged from 2.2-7% in those procedures without ultrasound guidance and 0-3.7% in procedures performed with ultrasound guidance [6,13,22,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44].…”

Section: Overall Incidence Of Pneumothorax and Impact Of Ultrasoundmentioning

confidence: 99%

Ultrasound for the Detection of Pleural Effusions and Guidance of the Thoracentesis Procedure

Sikora

Perera

Mailhot

et al. 2012

ISRN Emergency Medicine

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Objective. To review the use of ultrasound for the detection of pleural effusions and guidance of the thoracentesis procedure. Methods. Two clinical cases will be presented in which ultrasound proved beneficial in guiding the diagnosis and management of patients with pleural effusions and respiratory distress. The ultrasound techniques for the evaluation of pleural effusions and performance of the thoracentesis procedure are discussed. A review of the most current literature follows to present the known diagnostic and safety benefits of ultrasound guidance for thoracentesis. Conclusions. Ultrasound improves the diagnostic accuracy for the detection of pleural effusions over standard chest radiographs. Ultrasound can also diagnose a complicated pleural effusion that may be at higher risk for an adverse outcome during a thoracentesis. Optimally, thoracentesis should be performed under direct ultrasound guidance to decrease the complication rate and improve patient safety.

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“…Ultrasound offers the opportunity to guide the needle thoracentesis if the effusion is more significant and abundant ( Figure 6), as well as to avoid, during the lung re-expansion throughout and after drainage, the risk of pneumothorax (30,31). Also, since the ultrasound allows to make a diagnosis of the nature of the effusion (simple, loculated, organized), as well as to better distinguish the clouding visible to the chest x-ray (for example, to distinguish an effusion from a dully baseline pulmonary consolidation ) (13,14,16), it is possible to decide in advance which gauge needle must be used (20 G if the effusion is anechoic, 18 G if the effusion is corpusculated).…”

Section: Interventional Ultrasound-guided Procedures In Pleural Effusmentioning

confidence: 99%

Transthoracic ultrasound for pleural effusion: traps and tricks

Sperandeo¹

2014

sob

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SummaryPleural effusion is excess fluid that accumulates between the two pleural layers. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation. Pleural effusion is still usually diagnosed on the basis of medical history and physical examination, and confirmed by chest x-ray. It is observed in many pulmonary and extra-pulmonary disease; its cause can be relatively benign or definitely malign (cancer), and may require drainage for treatment or for achieving a diagnosis which is available at the bedside by physical examination and Thoracic Ultrasound (TUS). Pleural effusion is detected by TUS even when its volume is very little: it is possible to perform and repeat at bedside, by sufficiently trained physicians. Diagnostic intervention procedures are safer if performed using US probes specifically designed for this use, i.e. with a central hole which allows the co-axial passage of the disposable tools for drainage or Fine Needle Aspiration Biopsy (FNAB). Over-trusting in US criteria not evidence-based and, more important, which are demonstrated to be unreliable when critically re-appraised must be discouraged; reversal of such scarcely validated but recommended practices, which could be harmful for patients, is actively in progress also in this field of medicine. No special trick is needed and no actual trap is present when the assessment of pleural effusion is performed by a sufficiently skilled MD and with a reliable and well set echo machine. Echo-assisted thoracentesis is an excellent procedure when appropriately performed in all its phases, which are: choice of the site of insertion, visualization in real-time during the drainage and serial control during lung re-expansion (so as to avoid pneumothorax). KEY WORDS: ultrasound, pleural effusion. Transthoracic ultrasound: overviewThe ultrasound examination in the study of pleuro-pulmonary disease, i.e. Thoracic Ultra-Sound (TUS), is limited by the presence of air in the lungs and by the rib cage (1). As a consequence TUS is not an all purpose tool, drawbacks and appropriate indications must be the cynosure of the pneumologist which relies on TUS for diagnosis and management of patients (2). The presence of the bony structures of the rib cage restricts the success of ultrasound imaging of the pleural surface to about 70% of the total (3). These issues, relating to limitations on the use of ultrasound in the thoracic area, have been known since the ʼ60s, a time when pioneering works were published using A-mode for exploring pleuro-pulmonary structures and, namely, pleural effusion (4), even in comparison with radiological imaging and with a greater sensitivity and specificity (5). Thereafter these advantages were established in the few subsequent years, with minimal further refinements despite the technology of ultrasound equipment has evolved considerably (6, 7): the value of ultrasound examination of the pleura and lungs remains highly underestimated to this day, and overstatements (8) and over- Mini-review...

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Pneumothorax and the value of chest radiography after ultrasound-guided thoracocentesis

Abstract: US-guided thoracocentesis can be done equally as safely by residents as by senior radiologists. The safety and feasibility of the method are evident among mechanically ventilated intensive care patients. Our results do not support the routine use of post-thoracocentesis chest radiography.

Cited by 26 publications

References 12 publications

Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline

Ultrasound for the Detection of Pleural Effusions and Guidance of the Thoracentesis Procedure

Transthoracic ultrasound for pleural effusion: traps and tricks

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