Ultrasonography for the Diagnosis of Pneumothorax after Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases

Abstract

Background: Transbronchial lung cryobiopsy (TBLC) can be indicated in diffuse parenchymal lung diseases (DPLDs) when a confident noninvasive diagnosis cannot be made. The 2 most relevant complications of TBLC are bleeding and pneumothorax (PTX). The accuracy of chest ultrasonography (US) for the detection of PTX is higher when compared to chest X-ray (CXR) with reference to computed tomography (CT) scan as a gold standard. Objective: We evaluated the accuracy of chest US in detecting PTX after TBLC in patients with DPLDs. Methods: Patients underwent TBLC during rigid bronchoscopy in deep sedation. Cryobiopsy was performed with fluoroscopic guidance. Three hours later, patients underwent chest US and standard CXR. When there was no concordance between chest US and CXR, chest CT was required. Results: Forty-three patients were enrolled into the study. Cryobiopsy was performed in the right lung in 36 (84%) patients. PTX was diagnosed in 10 (23%) patients by CXR. There was complete agreement between radiologists interpreting CXR (k = 1, 95% CI 1). Chest US was positive for PTX in 11 (25%) patients. There was complete agreement between pulmonologists interpreting chest US (k = 1, 95% CI 1). The prevalence of PTX diagnosed by concordance of CXR and chest US was 23% (10/43, 95% CI 11.8-38.7). The sensitivity and specificity of chest US were 90% (95% CI 55.5-99.7) and 94% (95% CI 79.8-99.3), respectively. Moreover, the positive and negative predictive values were 82% (95% CI 48-98) and 97% (95% CI 84-100), respectively. Conclusion: Chest US is a highly sensitive and specific diagnostic tool for the diagnosis of PTX after TBLC.

Transbronchial Cryobiopsies for the Diagnosis of Diffuse Parenchymal Lung Diseases: Expert Statement from the Cryobiopsy Working Group on Safety and Utility and a Call for Standardization of the Procedure

“…A postprocedural chest X-ray or ultrasound examination should be performed to assess for the occurrence of pneumothorax either immediately (if desaturation, persistent cough and/or thoracic pain are present) or 2 h after the end of the procedure if the patient is asymptomatic [94]. This is particularly relevant if the patient is in the outpatient setting.…”

Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement

“…Chest radiograph is required to detect a pneumothorax in the postoperative period (generally 2–3 h after the procedure). [175779] Chest ultrasound performed by trained pulmonologists for the detection of pneumothorax following BLC has a sensitivity and specificity of 90% and 94%, respectively,[79] and is superior to a chest radiograph. [80] In a meta-analysis, chest ultrasonography had a pooled sensitivity and specificity of 78.6% (95% CI, 68.1–98.1) and 98.4% (95% CI, 97.3–99.5), respectively, for the detection of pneumothorax; while the sensitivity and specificity of chest radiography was 39.8% (95% CI, 29.4–50.3) and 99.3% (95% CI, 98.4–100), respectively.…”

Recommendations for Lung Ultrasound in Internal Medicine

“…Experts’ comments [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] The absence of the lung point with the simultaneous presence of pneumothorax occurs in cases of critical or mantle pneumothorax. Prior pleurodesis affects the presence of lung sliding (the sign will be absent or limited) and of vertical reverberation artifacts (artifacts emerge due to pleural line abnormalities).…”