0
Correspondence |

The Value of Chest Ultrasonography in Diagnosing Pneumothorax in Patients With TraumaChest Ultrasonography in Patients with Trauma FREE TO VIEW

Stewart Siu-Wa Chan, MBBS; Colin A. Graham, MD, FCCP; Timothy Hudson Rainer, MD
Author and Funding Information

From the Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong.

Correspondence to: Stewart Siu-Wa Chan, MBBS, Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, Hong Kong, China; e-mail: stewart_chan@hotmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(4):1127-1128. doi:10.1378/chest.11-3003
Text Size: A A A
Published online

Dr Baumann, in his editorial in CHEST (October 2011),1 comments on the higher sensitivity of ultrasonography compared with chest radiography in the detection of pneumothorax, as reported in a meta-analysis by Ding et al2 published in the same issue of the journal. He also suggests that more prospective, randomized studies are needed to demonstrate the comparative clinical effectiveness of ultrasonography. From our perspective as emergency physicians treating patients with trauma, the current available evidence seems to suggest that there is little value in incorporating chest ultrasonography in the evaluation of patients with blunt chest injury.

First, a retrospective study of patients with trauma and occult pneumothoraces (pneumothoraces not identified on chest radiography but diagnosed using thoracic CT imaging) found that 59 patients were managed by observation without tube thoracostomy, of which 51 cases (86%) were successful.3 For the eight patients in which delayed tube thoracostomy was required, five were placed because of the increasing size of the pneumothorax noted on chest radiography, two were placed prophylactically prior to exploratory laparotomy, and one was placed because of the increasing size of the pneumothorax noted on CT scans.

Second, in a series of blunt thoracic injuries from another level 1 trauma center, including 82 cases of occult pneumothoraces, clinical outcomes for patients in terms of mortality and duration of mechanical ventilation of patients with occult injuries (injuries not identified on chest radiography but diagnosed using thoracic CT imaging) were not significantly different from those patients with no abnormality on chest radiography and CT scans.4 The authors concluded that occult injuries have minimal clinical consequences.

Finally, in a retrospective study of 44 consecutive cases of occult pneumothoraces (same definition as in the previous paragraph) from blunt chest injury in our trauma center in Hong Kong, 36 patients were managed expectantly without significant complications. No pneumothoraces progressed even though eight patients were mechanically ventilated.5

Although the sensitivity of ultrasonography in detecting pneumothoraces approaches that of thoracic CT imaging (89% according to Ding et al),2 these three studies suggest that utilizing chest ultrasonography to detect pneumothoraces that may be missed by chest radiography is likely to have very little impact on improving clinical outcomes in the setting of a contemporary trauma system with modern CT scanners. We agree with Dr Baumann that more high-quality evidence, preferably from prospective randomized studies, is needed to establish the precise role of ultrasonography in this clinical setting, along with its cost-effectiveness, if any.

Other contributions: The work was performed at Prince of Wales Hospital, The Chinese University of Hong Kong.

Baumann MH. Chest ultrasonography: where’s the beef? Chest. 2011;1404:837-839 [CrossRef] [PubMed]
 
Ding W, Shen Y, Yang J, He X, Zhang M. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest. 2011;1404:859-866 [CrossRef] [PubMed]
 
Barrios C, Tran T, Malinoski D, et al. Successful management of occult pneumothorax without tube thoracostomy despite positive pressure ventilation. Am Surg. 2008;7410:958-961 [PubMed]
 
Kaiser M, Whealon M, Barrios C, et al. The clinical significance of occult thoracic injury in blunt trauma patients. Am Surg. 2010;7610:1063-1066 [PubMed]
 
Lee KL, Graham CA, Yeung JH, Ahuja AT, Rainer TH. Occult pneumothorax in Chinese patients with significant blunt chest trauma: incidence and management. Injury. 2010;415:492-494 [CrossRef] [PubMed]
 

Figures

Tables

References

Baumann MH. Chest ultrasonography: where’s the beef? Chest. 2011;1404:837-839 [CrossRef] [PubMed]
 
Ding W, Shen Y, Yang J, He X, Zhang M. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest. 2011;1404:859-866 [CrossRef] [PubMed]
 
Barrios C, Tran T, Malinoski D, et al. Successful management of occult pneumothorax without tube thoracostomy despite positive pressure ventilation. Am Surg. 2008;7410:958-961 [PubMed]
 
Kaiser M, Whealon M, Barrios C, et al. The clinical significance of occult thoracic injury in blunt trauma patients. Am Surg. 2010;7610:1063-1066 [PubMed]
 
Lee KL, Graham CA, Yeung JH, Ahuja AT, Rainer TH. Occult pneumothorax in Chinese patients with significant blunt chest trauma: incidence and management. Injury. 2010;415:492-494 [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543