Evaluation of the role of bedside ultrasonography in the detection of traumatic occult pneumothorax

Background

Primary management of pneumothorax is usually as simple as it can be done by junior physician. But diagnosis of pneumothorax is sometimes as difficult as it can be missed by senior physician and lead to serious complications that may endanger the patient's life.

Methods

This study was conducted on 80 polytraumatized adult patients, within the same day of trauma. They presented to the Emergency Department, Tanta University, Egypt with chest trauma in the period between October 2016 to the end of January 2018. All patients were subjected to chest X-ray either erect position when possible or supine position revealing no pneumothorax. Subsequently, all of those patients underwent thoracic ultrasonography prior to whole body CT scanning performed within 2 h of admission.

Results

Ultrasonography detected pneumothorax in 56 out of 62 patients having occult pneumothorax with sensitivity up to 90.32% and positive predictive value of 96.55%. On the other hand, ultrasonography succeeded in exclusion of occult pneumothorax in 16 out of 18 patients that were free of occult pneumothorax in their CT with specificity reaching 88.89% and negative predictive value of 72.73%, the overall accuracy was calculated to be 90%.

Conclusions

Bedside thoracic ultrasonography is a simple, rapid and reliable tool with high sensitivity, specificity and accuracy that can be depend on for diagnosis of occult pneumothorax in chest trauma patients.