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European Radiology

, Volume 15, Issue 5, pp 930–935 | Cite as

Value of high-resolution ultrasound in detecting a pneumothorax

  • Myung Jin Chung
  • Jin Mo GooEmail author
  • Jung-Gi Im
  • Jae Min Cho
  • Sung Bum Cho
  • Seog Joon Kim
Chest

Abstract

This study was designed to compare the detectability of high-resolution ultrasound (HRUS) and bedside chest radiography (CR) for a pneumothorax. During the last 14 months, 97 consecutive patients who were admitted to our institute to undergo a transthoracic needle aspiration and biopsy (TNAB) of the lung were included. Both HRUS and CR were performed immediately after the TNAB procedure. The HRUS images were saved in sequence using the cine-review mode and displayed as an animation on a workstation. Four radiologists independently analyzed both HRUS images and a soft copy of the CR on a diagnostic monitor and identified the pneumothorax. With CT as the reference standard, statistical parameters were calculated. From 97 patients, 35 pneumothorax cases were found on CT after the TNAB. The sensitivities in detecting the pneumothorax were 80 and 47% in HRUS and CR, respectively. The specificities were 94 and 94%. The diagnostic accuracies were 89 and 77%. The inter-observer agreement was excellent (κ=0.85) in the HRUS images and moderate (κ=0.49) in the CR. The results of this study suggest that HRUS is a more sensitive and confident method for diagnosing a pneumothorax when compared to bedside chest radiography.

Keywords

Ultrasound, comparative study Ultrasound, utilization Thorax, US Pneumothorax 

References

  1. 1.
    Kirkpatrick AW, Ng AK, Dulchavsky SA, Lyburn I, Harris A, Torregianni W, Simons RK, Nicolaou S (2001) Sonographic diagnosis of a pneumothorax inapparent on plain radiography: confirmation by computed tomography. J Trauma 50:750–752PubMedGoogle Scholar
  2. 2.
    Chiles C, Ravin CE (1986) Radiographic recognition of pneumothorax in the intensive care unit. Crit Care Med 19:906–910Google Scholar
  3. 3.
    Tocino IM, Miller MH, Fairfax WR (1985) Distribution of pneumothorax in the supine and semirecumbent critically ill adult. Am J Roentgenol 144:901–905Google Scholar
  4. 4.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedGoogle Scholar
  5. 5.
    Sistrom CL, Reiheld CT, Spencer BG, Wallace KK (1996) Detection and estimation of the volume of pneumothorax using real-time sonography. Am J Roentgenol 166:317–321Google Scholar
  6. 6.
    Rantanen NW (1986) Diseases of the thorax. Vet Clin North Am Equine Pract 2:49–66PubMedGoogle Scholar
  7. 7.
    Wernecke K, Galanski M, Peters PE, Hansen J (1987) Pneumothorax: evaluation by ultrasound—preliminary results. J Thorac Imaging 2:76–78PubMedGoogle Scholar
  8. 8.
    Targhetta R, Bourgeois JM, Balmes P (1990) Echography of pneumothorax. Rev Mal Respir 7:575–579PubMedGoogle Scholar
  9. 9.
    Targhetta R, Bourgeois JM, Chavagneux R, Balmes P (1992) Diagnosis of pneumothorax by ultrasound immediately after ultrasonically guided aspiration biopsy. Chest 101:855–856PubMedGoogle Scholar
  10. 10.
    Targhetta R, Bourgeois JM, Chavagneux R, Coste E, Amy D, Balmes P, Pourcelot L (1993) Ultrasonic signs of pneumothorax: preliminary work. J Clin Ultrasound 21:245–250PubMedGoogle Scholar
  11. 11.
    Lichtenstein DA, Menu Y (1995) A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest 108:1345–1348PubMedGoogle Scholar
  12. 12.
    Sistrom CL, Reiheld CT, Gay SB, Wallace KK (1996) Detection and estimation of the volume of pneumothorax using real-time sonography: efficacy determined by receiver operating characteristic analysis. Am J Roentgenol 166:317–321Google Scholar
  13. 13.
    Lichtenstein D, Meziere G, Biderman P, Gepner A (1999) The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 25:383–388CrossRefPubMedGoogle Scholar
  14. 14.
    Lichtenstein D, Meziere G, Biderman P, Gepner A (2000) The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med 26:1434–1440CrossRefPubMedGoogle Scholar
  15. 15.
    Dulchavsky SA, Schwarz KL, Kirkpatrick AW, Billica RD, Williams DR, Diebel LN, Campbell MR, Sargysan AE, Hamilton DR (2001) Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. J Trauma 50:201–205PubMedGoogle Scholar
  16. 16.
    Carr JJ, Reed JC, Choplin RH, Pope TL Jr, Case LD (1992) Plain and computed radiography for detecting experimentally induced pneumothorax in cadavers: implications for detection in patients. Radiology 183:193–199PubMedGoogle Scholar
  17. 17.
    Sargsyan AE, Hamilton DR, Nicolaou S, Kirkpatrick AW, Campbell MR, Billica RD, Dawson D, Williams DR, Melton SL, Beck G, Forkheim K, Dulchavsky SA (2001) Ultrasound evaluation of the magnitude of pneumothorax: a new concept. Am Surg 67:232–235PubMedGoogle Scholar
  18. 18.
    Oikonomou A, Matzinger FR, Seely JM, Dennie CJ, Macleod PJ (2004) Ultrathin needle (25 G) aspiration lung biopsy: diagnostic accuracy and complication rates. Eur Radiol 14:375–382CrossRefPubMedGoogle Scholar
  19. 19.
    Topal U, Ediz B (2003) Transthoracic needle biopsy: factors effecting risk of pneumothorax. Eur J Radiol 48:263–267CrossRefPubMedGoogle Scholar
  20. 20.
    Geraghty PR, Kee ST, McFarlane G, Razavi MK, Sze DY, Dake MD (2003) CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 229:475–481PubMedGoogle Scholar
  21. 21.
    Anderson JM, Murchison J, Patel D (2003) CT-guided lung biopsy: factors influencing diagnostic yield and complication rate. Clin Radiol 58:791–797Google Scholar
  22. 22.
    Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ (2004) Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 100:9–15CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Myung Jin Chung
    • 1
  • Jin Mo Goo
    • 2
    Email author
  • Jung-Gi Im
    • 2
  • Jae Min Cho
    • 1
  • Sung Bum Cho
    • 3
  • Seog Joon Kim
    • 4
  1. 1.Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  2. 2.Department of Radiology, Clinical Research InstituteSeoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRCSeoulSouth Korea
  3. 3.Department of RadiologyKorea University College of MedicineSeoulSouth Korea
  4. 4.Department of RadiologyHandong University Sunlin HospitalPohangSouth Korea

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