Pneumothorax Detection with Thoracic Ultrasound As the Method of Choice in Interventional Pulmonology - A Retrospective Single-center Analysis and Experience

Overview

Journal BMC Pulm Med

Publisher Biomed Central

Specialty Pulmonary Medicine

Date 2023 Jun 26

PMID 37365532

Authors

Sonja Sieber

Jakob Garbe

Sebastian Bohm

Stephan Eisenmann

Affiliations

Soon will be listed here.

Abstract

Background: Recent studies have shown that thoracic ultrasound (TUS) is not inferior to chest radiography (CR) in detecting pneumothorax (PTX). It is unclear if adopting TUS can reduce the number of CR in the daily clinical routine. This retrospective study investigates the utilization of post-interventional CR and TUS for PTX detection after the introduction of TUS as the method of choice in an interventional pulmonology unit.

Methods: All interventions with CR or TUS for ruling out PTX performed in the Pneumology Department of the University Hospital Halle (Germany) 2014 to 2020 were included. The documented TUS and CR performed before (period A) and after the introduction of TUS as the method of choice (period B), as well as the number of diagnosed and missed PTX were recorded.

Results: The study included 754 interventions (110 in period A and 644 in period B). The proportion of CR decreased from 98.2% (n = 108) to 25.8% (n = 166) (p < 0.001). During period B, a total of 29 (4.5%) PTX were diagnosed. Of these, 28 (96.6%) were detected on initial imaging (14 by CR, 14 by TUS ). One PTX (0.2%) was initially missed by TUS, none by CR. Confirmatory investigations were ordered more frequently after TUS (21 of 478, 4.4%) than after CR (3 of 166, 1.8%).

Conclusion: The use of TUS in interventional pulmonology can effectively reduce the number of CR and thus save resources. However, CR may still be favored in specific circumstances or if pre-existing conditions limit sonographic findings.

References

Volpicelli G . Sonographic diagnosis of pneumothorax. Intensive Care Med. 2010; 37(2):224-32. DOI: 10.1007/s00134-010-2079-y. View

Lichtenstein D, Lascols N, Prin S, Meziere G . The "lung pulse": an early ultrasound sign of complete atelectasis. Intensive Care Med. 2003; 29(12):2187-2192. DOI: 10.1007/s00134-003-1930-9. View

Goodman T, Traill Z, Phillips A, Berger J, Gleeson F . Ultrasound detection of pneumothorax. Clin Radiol. 1999; 54(11):736-9. DOI: 10.1016/s0009-9260(99)91175-3. View

Alrajhi K, Woo M, Vaillancourt C . Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest. 2011; 141(3):703-708. DOI: 10.1378/chest.11-0131. View

Brogi E, Bignami E, Sidoti A, Shawar M, Gargani L, Vetrugno L . Could the use of bedside lung ultrasound reduce the number of chest x-rays in the intensive care unit?. Cardiovasc Ultrasound. 2017; 15(1):23. PMC: 5597991. DOI: 10.1186/s12947-017-0113-8. View

Sartori S, Tombesi P, Trevisani L, Nielsen I, Tassinari D, Abbasciano V . Accuracy of transthoracic sonography in detection of pneumothorax after sonographically guided lung biopsy: prospective comparison with chest radiography. AJR Am J Roentgenol. 2006; 188(1):37-41. DOI: 10.2214/AJR.05.1716. View

Lichtenstein D, Menu Y . A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. 1995; 108(5):1345-8. DOI: 10.1378/chest.108.5.1345. View

Galbois A, Ait-Oufella H, Baudel J, Kofman T, Bottero J, Viennot S . Pleural ultrasound compared with chest radiographic detection of pneumothorax resolution after drainage. Chest. 2010; 138(3):648-55. DOI: 10.1378/chest.09-2224. View

Shafiq M, Lee H, Yarmus L, Feller-Kopman D . Recent Advances in Interventional Pulmonology. Ann Am Thorac Soc. 2019; 16(7):786-796. DOI: 10.1513/AnnalsATS.201901-044CME. View

10.

Shostak E, Brylka D, Krepp J, Pua B, Sanders A . Bedside sonography for detection of postprocedure pneumothorax. J Ultrasound Med. 2013; 32(6):1003-9. PMC: 4041153. DOI: 10.7863/ultra.32.6.1003. View

11.

Baumann M, Noppen M . Pneumothorax. Respirology. 2004; 9(2):157-64. DOI: 10.1111/j.1440-1843.2004.00577.x. View

12.

Lentz R, Argento A, Colby T, Rickman O, Maldonado F . Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges. J Thorac Dis. 2017; 9(7):2186-2203. PMC: 5542930. DOI: 10.21037/jtd.2017.06.96. View

13.

MacDuff A, Arnold A, Harvey J . Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010; 65 Suppl 2:ii18-31. DOI: 10.1136/thx.2010.136986. View

14.

Beres R, Goodman L . Pneumothorax: detection with upright versus decubitus radiography. Radiology. 1993; 186(1):19-22. DOI: 10.1148/radiology.186.1.8416563. View

15.

Viglietta L, Inchingolo R, Pavano C, Tomassetti S, Piciucchi S, Smargiassi A . Ultrasonography for the Diagnosis of Pneumothorax after Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases. Respiration. 2017; 94(2):232-236. DOI: 10.1159/000477818. View

16.

Garofalo G, Busso M, Perotto F, De Pascale A, Fava C . Ultrasound diagnosis of pneumothorax. Radiol Med. 2006; 111(4):516-25. DOI: 10.1007/s11547-006-0047-y. View

17.

Chung M, Goo J, Im J, Cho J, Bum Cho S, Kim S . Value of high-resolution ultrasound in detecting a pneumothorax. Eur Radiol. 2004; 15(5):930-5. DOI: 10.1007/s00330-004-2518-7. View

18.

Monti J, Younggren B, Blankenship R . Ultrasound detection of pneumothorax with minimally trained sonographers: a preliminary study. J Spec Oper Med. 2009; 9(1):43-46. DOI: 10.55460/9GWU-MQO4. View

19.

Schnell J, Beer M, Eggeling S, Gesierich W, Gottlieb J, Herth F . Management of Spontaneous Pneumothorax and Postinterventional Pneumothorax: German S3-Guideline. Zentralbl Chir. 2018; 143(S 01):S12-S43. DOI: 10.1055/a-0588-4444. View

20.

Cantey E, Walter J, Corbridge T, Barsuk J . Complications of thoracentesis: incidence, risk factors, and strategies for prevention. Curr Opin Pulm Med. 2016; 22(4):378-85. PMC: 8040091. DOI: 10.1097/MCP.0000000000000285. View