Jones & Bartlett Learning Medicine Blog

    Ultrasound is More Sensitive Than Chest X-ray for Detection of a Pneumothorax

    Posted by Joseph Esherick on Apr 24, 2012 4:26:04 PM


    Pneumothoraces are a common problem in the ER and the ICU.  The traditional screening test for a pneumothorax in the hospital is the chest radiograph; however, chest radiographs are not very sensitive in the setting of trauma and in ventilated patients.  A recent study of 225 trauma patients demonstrated that an AP chest x-ray had only 20.9% sensitivity for detecting a pneumothorax versus a CT scan of the chest.[1] A chest CT scan is the gold standard for the diagnosis of a pneumothorax, but a CT scan is extremely expensive and exposes a patient to about 7 mSv radiation (the equivalent of 70 chest x-rays).  Another modality that is gaining traction as the principal diagnostic modality to evaluate for post-traumatic pneumothoraces is a transthoracic ultrasound.  Thoracic ultrasound look for the presence or absence of lung sliding, comet tail artifacts, A line, a lung point, and a “Seashore sign” or “Bar code sign” on M Mode sonography to determine whether a pneumothorax is present.  A transthoracic ultrasound takes only a few minutes to perform and is performed as a part of the E-FAST exam right in the trauma bay of the ER.  It costs nothing, is associated with no radiation exposure, and requires no transport of the patient.

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    Topics: CT scan, Dr. Joseph Esherick, Authors, Pneumothorax, x-ray, Hospital Medicine Blog, E-FAST, sonography, thoracic

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