Prospective Evaluation of Thoracic Ultrasound in the Detection of Pneumothorax

TLDR

Thoracic ultrasound can rapidly diagnose pneumothorax when radiographs are unobtainable, but its accuracy in this setting has not been established. This study prospectively evaluated the diagnostic accuracy of thoracic ultrasound for pneumothorax in patients with high clinical suspicion. Ultrasound examinations assessed lung sliding and comet‑tail artifacts by trained residents and were compared with standard radiography in 382 trauma patients of various injury mechanisms. Ultrasound detected 37 of 39 radiographically confirmed pneumothoraces (95 % sensitivity) with a 100 % true‑negative rate, demonstrating reliable diagnosis and supporting the inclusion of thoracic assessment in FAST protocols for both terrestrial and space medicine.

Abstract

Thoracic ultrasound may rapidly diagnose pneumothorax when radiographs are unobtainable; the accuracy is not known.We prospectively evaluated thoracic ultrasound detection of pneumothorax in patients at high suspicion of pneumothorax. The presence of "lung sliding" or "comet tail" artifacts were determined in patients by ultrasound before radiologic verification of pneumothorax by residents instructed in thoracic ultrasound. Results were compared with standard radiography.There were 382 patients enrolled; the cause of injury was blunt (281 of 382), gunshot wound (22 of 382), stab wound (61 of 382), and spontaneous (18 of 382). Pneumothorax was demonstrated on chest radiograph in 39 patients and confirmed by ultrasound in 37 of 39 patients (95% sensitivity); two pneumothoraces could not be diagnosed because of subcutaneous air; the true-negative rate was 100%.Thoracic ultrasound reliably diagnoses pneumothorax. Expansion of the focused abdominal sonography for trauma (FAST) examination to include the thorax should be investigated for terrestrial and space medical applications.