SESSION TITLE: Imaging Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: Medical thoracoscopy is a diagnostic and therapeutic procedure performed to visualize the structures of the pleural space, to perform biopsies and pleurodesis. Induction of a pneumothorax is necessary prior to the beginning of medical thoracoscopy in order to minimize the risk of injury to the lung or adjacent solid organs at the time of trocar insertion. Classically a chest radiograph has been used to confirm separation of the lung from the chest wall prior to the start of the procedure. The radiographic documentation of pneumothorax incurs radiation exposure, unnecessary expense and delays.Thoracic ultrasound is a noninvasive and readily available imaging modality that has important applications in diagnosis of pleural effusions and pneumothorax. It is performed at bedside. There is no time delay which is inherent to standard radiographic techniques. We propose that using bedside ultrasound to confirm induced pneumothorax prior to medical thoracoscopy is not only effective but also time and cost saving and prevents unnecessary radiation exposure.
METHODS: A prospective observational study was conducted. From December 2011 to November 2012, 10 patients underwent medical thoracoscopy. The indications for medical thoracoscopy included pleural biopsy for pleural effusions of unknown etiology, abnormal pleural findings on chest CT, and pleurodesis for malignant pleural effusions. All consecutive patients were enrolled independent of their underlying disease.
RESULTS: Both ultrasonography and chest radiography were performed in all 10 patients at bedside. Thoracic ultrasound was performed before and after induction of pneumothorax. Normal lung was depicted on the ultrasound on 2D images and M-Mode as Shore sign consistent with sliding lung. Pneumothorax was confirmed by observing the stratosphere sign consistent with absence of sliding lung. In all 10 cases, both thoracic ultrasound and chest radiograph confirmed the presence of pneumothorax. Using Fisher Exact Test, the difference between ultrasonography and chest radiograph in detection of penumothorax was not statistically significant (P=1.000). The average time to obtain a bedside chest radiograph was 40-60 minutes, while ultrasound allowed immediate feedback.
CONCLUSIONS: Bedside thoracic ultrasonography to confirm induced pneumothorax prior to medical thoracoscopy is an effective alternative to chest radiography.
CLINICAL IMPLICATIONS: Bedside thoracic ultrasound will minimize radiation exposure and may have significant time and cost saving implications.
DISCLOSURE: The following authors have nothing to disclose: Farhad Mazdisnian, Lianne Lin, Thomas Waddington, Behrouz Jafari, Catherine Sassoon
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