Diagnosis of Traumatic Pneumothorax Using Thoracic Ultrasonography
Date First Published:
May 4, 2024
Last Updated:
July 10, 2024
Report by:
Mason Gay MD, Christian Kolacki MD, EM senior resident, EM faculty (Corewell Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI)
Search checked by:
Jeffrey S. Jones MD, Corewell Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI
Three-Part Question:
For [patients with acute shortness of breath], is using [thoracic ultrasound] more sensitive than [chest radiography] in [detecting traumatic pneumothorax]?
Clinical Scenario:
A 45-year-old man presents to the emergency department after a motor vehicle accident. His only complaints are shortness of breath and abdominal pain. A focused assessment with sonography in trauma (FAST exam) is used to evaluate the patient's abdomen and chest. You wonder what is the accuracy of extending the FAST to detect pneumothorax.
Search Strategy:
Medline 1966-05/24 using PubMed, Cochrane Library (2024), and Embase
Search Details:
[(pneumothorax AND ultrasonography) AND (sensitivity OR specificity)] LIMIT to English language.
Outcome:
294 total articles were found, one systematic review and one clinical study were identified as both relevant and of sufficient quality for inclusion.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Role of emergency chest ultrasound in traumatic pneumothorax. An updated meta-analysis. Tian H, Zhang T, Zhou Y, Rastogi S, Choudhury R, Iqbal J. Mar-23 China/India | 12 prospective studies with trauma patients attending emergency department | Meta-analysis | Sensitivity of US | 89% (95% CI, 86-91%) | Subgroup analysis showed that the sampling method, setting (trauma vs. non-trauma), operator type and probe were significant sources of heterogeneity |
| Specificity of US | 96% (95% CI, 95-97%) | ||||
| Diagnostic odds ratio | 193.94 (95% CI, 59.0-637.4) | ||||
| Comparing Sensitivity and Specificity of Ultrasonography With Chest Radiography in Detecting Pneumothorax and Hemothorax in Chest Trauma Patients: A Cross-Sectional Diagnostic Study Aswin K, Balamurugan S, Govindarajalou R, Saya GK, Elamurugan TP, Rajendran G. Aug-23 India | All consecutive patients (n=255) with a suspected history of chest trauma | Cross-sectional diagnostic study | Sensitivity of bedside US compared to CXR | 85.7% versus 71.4% | Composite gold standard was used, not all patients had a computerized tomography (CT) scan. |
| Specificity of bedside US compared to CXR | 95.3% versus 100% |
Author Commentary:
The lack of lung sliding on an extended FAST (eFAST) is usually pathognomonic of a pneumothorax, especially in the context of trauma. Even though eFAST is more sensitive than a plain CXR for pneumothorax, it may not be as specific.
Bottom Line:
Thoracic ultrasound (or eFAST) is a rapid and reliable tool to diagnose pneumothorax.
References:
- Tian H, Zhang T, Zhou Y, Rastogi S, Choudhury R, Iqbal J. . Role of emergency chest ultrasound in traumatic pneumothorax. An updated meta-analysis.
- Aswin K, Balamurugan S, Govindarajalou R, Saya GK, Elamurugan TP, Rajendran G. . Comparing Sensitivity and Specificity of Ultrasonography With Chest Radiography in Detecting Pneumothorax and Hemothorax in Chest Trauma Patients: A Cross-Sectional Diagnostic Study