Chest
Volume 138, Issue 3, September 2010, Pages 648-655
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Original Research
Interventional Pulmonology
Pleural Ultrasound Compared With Chest Radiographic Detection of Pneumothorax Resolution After Drainage

https://doi.org/10.1378/chest.09-2224Get rights and content

Background

Pleural ultrasonography (PU) is more sensitive than chest radiograph (CXR) for diagnosing pneumothorax and could be useful for detecting resolution of pneumothorax after drainage. The aim of this prospective double-blind observational study was to assess PU accuracy during pneumothorax follow-up after drainage.

Methods

All patients hospitalized with pneumothorax requiring drainage were eligible. After drainage, residual pneumothorax was assessed by CXR and PU (1) 24 h after bubbling in the aspiration device had stopped, (2) 6 h after clamping the pleural catheter, and (3) 6 h after removing the pleural catheter. Pneumothorax indicated by PU but not CXR was confirmed by CT scan or by aspiration of > 10 mL of air.

Results

Forty-four unilateral pneumothoraces were studied (primary spontaneous: 70.5%), and 162 pairs of examinations (CXR and PU) were performed. Twenty residual pneumothoraces were detected by both CXR and PU. Furthermore, PU suspected 14 pneumothoraces that were not identified by CXR; 13 were confirmed. All of these pneumothoraces resulted in therapeutic intervention. Thus, 39% (13/33) of the confirmed residual pneumothoraces were missed by CXR. In patients with primary spontaneous pneumothorax, the positive predictive value of PU for residual pneumothorax diagnosis was 100%; for other pneumothoraces, this value ranged from 90% in the absence of a lung point to 100% when a lung point was observed. PU results were obtained faster than results from CXR (35 ± 34 min vs 71 ± 56 min, P < .0001).

Conclusions

The accuracy of PU is excellent for detecting residual pneumothorax during pneumothorax follow-up after drainage.

Section snippets

Design

Between November 2007 and May 2009, we conducted a prospective observational study in a four-bed intermediate care unit that houses all patients with pneumothorax requiring drainage in our tertiary teaching hospital. This unit is part of a 14-bed medical ICU that has 1,080 admissions a year. In this ICU, ultrasonography is a routine part of patient care. All patients with pneumothorax requiring drainage were eligible for the study, and informed consent was required before inclusion. Exclusion

Patients

Fifty-one patients admitted between November 2007 and May 2009 had pneumothorax requiring drainage. Five patients were excluded because they were on mechanical ventilation, and two were excluded because of important subcutaneous emphysema that impaired pleural line visualization on PU. The final analysis included 44 patients with unilateral pneumothorax (mean age, 37.5 ± 15.0 years; men, n = 31 [70.5%]). Pneumothorax cause was as follows: primary spontaneous (n = 31, 70.5%), traumatic (n = 7,

Discussion

This is the first study to our knowledge to show that PU is better than CXR for detecting residual pneumothoraces after drainage and that 39% of them were not identified by CXR. We confirmed that results of PU are obtained more rapidly than results of CXR.14, 29 Finally, the learning curve showed that naïve residents were able to perform reliable PU after 2 h of training.

The lung point is an inconstant sign, but has a specificity of 100% for pneumothorax diagnosis.24 The fact that the PPV of PU

Conclusions

This study showed that PU diagnostic performance was excellent for pneumothorax follow-up after drainage. PU offered several advantages over CXR: PU diagnosed all residual pneumothoraces, many of which were not identified by CXR; PU led to extra therapeutic interventions; PU gave faster results than CXR; and PU was performed competently by naïve physicians after a brief (2-h) training session.

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