RT Journal Article
SR Electronic
T1 The role of transthoracic ultrasound (TTS) in the diagnosis and management of post transbronchial lung biopsy (TBLB) pnemothorax (PTX)
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P292
VO 40
IS Suppl 56
A1 Sachin Kumar
A1 Dheeraj Gupta
A1 Ritesh Agarwal
A1 Ashutosh Aggarwal
A1 Surinder Kumar Jindal
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/P292.abstract
AB BACKGROUNDTTS increasingly being used to detect PTX, however its utility in diagnosis and management of post TBLB PTX largely unknown.OBJECTIVETo evaluate the accuracy of TTS in detection of post TBLB PTX.SUBJECTS AND METHODSTTS performed on 379 consecutive patients undergoing flexible bronchoscopy and TBLB (n=113). Disappearance of sliding lung and comettail artifacts considered evidence of PTX. Upright chest radiography (CXR) was performed after 2 hours of TBLB. CT chest performed in case of discrepancy between TTS and CXR. PTX was sonographically monitored by noting position of the lung point 2 hrly.RESULTSPTX occurred in eight (7.1%) of TBLB patients. TTS depicted all cases of PTX while CXR did not depict one PTX, which was confirmed on CT. All PTX diagnosed immediately post procedure by TTS in the bronchoscopy suite itself. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were all 100% for TTS and 87.5%, 100%, 100%, 99.6%, and 99.6%, respectively, for CXR. The 95% confidence intervals (CI) for the sensitivity, negative predictive value, and overall accuracy were 46.7% to 99.3%, 95.6% to 100%, and 56.1% to 100% for CXR. Any shift of the lung point towards the base of lungs(below Mid thoracic line) favored single time aspiration (done in 2 cases) or ICTD insertion(1 case),while conservative management done in cases where lung point shifted towards apex(Above Mid thoracic line).CONCLUSION These preliminary results suggest that TTS is as effective as CXR in the detection of PTX after TBLB and may become the method of choice for excluding, diagnosing, and monitoring PTX after TBLB.