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Michael Y. Woo, MD; Khaled Alrajhi, MD; Christian Vaillancourt, MD
Author and Funding Information

From the Department of Emergency Medicine, University of Ottawa.

Correspondence to: Michael Y. Woo, MD, Department of Emergency Medicine, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada; e-mail: mwoo@ottawahospital.on.ca


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. See online for more details.


Chest. 2012;142(2):538-539. doi:10.1378/chest.12-0893
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To the Editor:

We thank Drs Peris and Barbani for their interest in our CHEST article (March 2012)1 on ultrasonography for the diagnosis of pneumothorax. Our search strategy for the meta-analysis did not include any restrictions by etiology. Only the articles that met the predefined inclusion criteria were included, none of which was performed on ventilated patients. The presence or absence of lung sliding and/or comet tails allows the ultrasonographer to recognize the presence of air in the pleural space (pneumothorax), regardless of its etiology. It is our opinion that there is no physiologic or sonographic reason to believe that ultrasonography would perform differently when the etiology is different. It is, however, the case that preexisting or concurrent conditions like the presence of ARDS can lead to false-positive ultrasonography studies.2 As this was not the objective of our study, we have not discussed this, but as Drs Peris and Barbani point out, it warrants further exploration.

Drs Peris and Barbani comment on the limited number of radiographs performed in the semirecumbent position. We were unable to find studies comparing the performance of supine and semirecumbent radiographs in a clinical setting to diagnose pneumothorax. We do see some difference between those in clinical practice, but it is unclear as to the magnitude of that difference and whether there is a change in position of ultrasonography when compared with radiographs for the detection of pneumothorax. We agree that further research in this area may clarify the issue.

Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest. 2012;141(3):703-708.
 
Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. 1995;108(5):1345-1348.
 

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Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest. 2012;141(3):703-708.
 
Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. 1995;108(5):1345-1348.
 
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