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Correspondence |

Lung PointLung Point: Not for Everyone: Not for Everyone FREE TO VIEW

Narendrakumar Alappan, MD; Creticus Petrov Marak, MD
Author and Funding Information

From the Department of Pulmonary and Critical Care, Montefiore Medical Center, Albert Einstein College of Medicine.

Correspondence to: Narendrakumar Alappan, MD, Department of Pulmonary and Critical Care, Albert Einstein College of Medicine, Pulmonary Centennial 4, 111 E 210th St, Bronx, NY 10467; e-mail: nalappa@montefiore.org


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. 2013;143(6):1837-1838. doi:10.1378/chest.13-0338
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To the Editor:

We read with great interest the article by Oveland et al1 in a recent issue of CHEST (February 2013). We would like to thank the authors for demonstrating in an evidence-based manner the long-believed concept favoring the use of lung ultrasonography in the prediction of progression of pneumothorax. Among all the ultrasonographic signs of pneumothorax, the demonstration of lung point is the only one with 100% specificity and, unfortunately, the one with the least sensitivity.

In the seminal article by Lichtenstein et al2 in 2000, the “lung point” was observed only in 44 of 66 cases of pneumothorax, yielding overall sensitivity of 66%. The sensitivity increased to 75% (six of eight subjects) in subjects with occult pneumothorax. In another retrospective analysis by the same author, lung point was present in 34 of 43 cases of occult pneumothorax, yielding a sensitivity of 79% and a specificity of 100%.3 The difficulty in identifying a lung point is evident even in this present study, wherein there is a significant discrepancy in the number of times the interpreting anesthesiologists were able to locate the lung point in anterior and posterior locations.1 Moreover, the limitations of obtaining this sign in real-world critically ill patients are many and include coexistence of subcutaneous emphysema, pleural calcifications, thoracic dressings, and obese body habitus. Although this study proved a good correlation of ultrasonographic examination compared with CT scan in the progression of pneumothorax, the practical applications are questionable for the above-mentioned reasons.

References

Oveland NP, Lossius HM, Wemmelund K, Stokkeland PJ, Knudsen L, Sloth E. Using thoracic ultrasonography to accurately assess pneumothorax progression during positive pressure ventilation: a comparison with CT scanning. Chest. 2013;143(2):415-422. [PubMed]
 
Lichtenstein D, Mezière G, Biderman P, Gepner A. The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26(10):1434-1440. [CrossRef] [PubMed]
 
Lichtenstein DA, Mezière G, Lascols N, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33(6):1231-1238. [CrossRef] [PubMed]
 

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References

Oveland NP, Lossius HM, Wemmelund K, Stokkeland PJ, Knudsen L, Sloth E. Using thoracic ultrasonography to accurately assess pneumothorax progression during positive pressure ventilation: a comparison with CT scanning. Chest. 2013;143(2):415-422. [PubMed]
 
Lichtenstein D, Mezière G, Biderman P, Gepner A. The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med. 2000;26(10):1434-1440. [CrossRef] [PubMed]
 
Lichtenstein DA, Mezière G, Lascols N, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med. 2005;33(6):1231-1238. [CrossRef] [PubMed]
 
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