Ultrasound Detection of Pneumothorax

Atanas Dimitrov Hilendarov, Antonia Ivanova Nedeva, Kichka Georgieva Velkova

Introduction Lung sonography has rapidly emerged as a reliable technique in the evaluation of various thoracic diseases. Accurate diagnosis of a pneumothorax in the management of a critical patient can prevent the life-threatening situation. The aim. This article offers our experience of the use of thoracic ultrasound in the diagnosis of a pneumothorax, reviews the proper techniques used, and highlights its clinical utility. Materials and Methods The study study was carried out between June 2015 and September 2016 year. Lung sonography was performed on 110 patients -89 at the Emergency Department and 21 at the betside due to unstability of the patient. The probe is placed in a sagittal position on the anterior chest wall at about the second intercostal space, in the mid-clavicular line. During ultrasonography, the patient is sitting with arms elevated and the hand positioned behind the neck. A 3.5 MHz linear array transducer is used in all the cases and in some cases a straight linear array high frequency probe (5–13 MHz).Results Sixty-five/71.5%/ of all 110 patients, witch can be divided into two broad categories: traumatic in 59 cases (including iatrogenic) or 6 atraumatic, are with sonographic signs of pneumothorax. The patients with confirmed pneumothorax are presented with one or more ultrasound signs- in 45 patients -absence of lung sliding, in 32 - ‘barcode’ often called the ‘stratosphere sign’, in 13- loss of ‘comet-tail artifacts’, in 34- ‘A-lines’, 14 with ‘lung-point sign’, and in 54 the ‘power slide’ with loss of ‘lung pulse’. 35 of the patients are treated by VATS complete pleurectomy and 5 patients submitted to VATS pleural abrasion. Conclusions Thoracic sonography for the detection of pneumothorax has become a well-established modality in the acute care setting. It is indispensible in the blunt or penetrating chest trauma patient, where the identification of a pneumothorax can prevent life-threatening consequences.