Comparison of upright inspiratory and expiratory chest radiographs for detecting pneumothoraces.

Seow, Albert; Kazerooni, Ella A.; Pernicano, Perry G.; Neary, Maureen P.

doi:10.2214/ajr.166.2.8553937

Cited by 71 publications

(33 citation statements)

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“…When considering the interobserver study population, there is statistically no significant difference (McNemar test alpha = 0.05) between inspiration/expiration for the diagnosis of pneumothorax. This, as well as a mean sensitivity of 86.1 % for the diagnosis of pneumothorax in both respiratory layers, is consistent with the study by Seow et al [27]. During observation of all 139 evaluated pneumothoraces (131 patients) it was demonstrated in the majority of cases -contrary to the generally accepted view [13, 15 -17, 19 -23] -the pleural space is greater during inspiration than during expiration.…”

supporting

confidence: 91%

“…The cause may be communication of the pleural space with intrapulmonary or outside air; the gap increases during inspiration due to trapped air and the elastic restoration force of the healthy lung. It has also been demonstrated that on the whole, pneumothoraces are more frequently detected during inspiration than during expiration; this is likewise congruent with the results of Seow et al [27]. If one takes location into account, apical and lateral pneumothoraces on average are wider during expiration (by 2.7 mm ± 0.8 mm) than during inspiration.…”

supporting

confidence: 86%

“…In the end, 131 patients with 139 pneumothoraces (8 patients had bilateral pneumothorax) who were diagnosed in at least one respiratory position were included in the study. Based on the work of Seow et al [27], 55 of the 131 patients were randomly assigned to this interobserver study. In addition, another 61 patients were also reevaluated by a medical specialist and randomly selected from the group of patients without pneumothorax (1481 patients = 90.6 % of the entire group) ( • " Fig.…”

Section: Patient Selection and Study Populationmentioning

confidence: 99%

“…Numerous authors share this opinion [1,3,17,20,22,24,26,27,29,30]. If we apply this knowledge to the possible occurrence of secondary diagnoses in cases of suspected pneumothorax, then it can be presumed that they can be more reliably diagnosed during inspiration.…”

mentioning

confidence: 99%

“…With respect to the literature [1,5,19,26,27,31,32], our study population is on the whole representative; however, the average age is slightly older in comparison, primarily due to the higher proportion of patients with post-interventional or postoperative pneumothorax (after pacemaker implantation, defibrillation or cardiac surgery).…”

mentioning

confidence: 99%

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Value of Digital Radiography in Expiration in Detection of Pneumothorax

Thomsen

Natho

Feigen

et al. 2013

Fortschr Röntgenstr

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!Purpose: The purpose of this study was to find out whether pneumothorax detection and exclusion is superior in expiratory digital chest radiography. Materials and Methods: 131 patients with pneumothorax with paired inspiratory and expiratory chest radiographs were analyzed regarding localization and size of pneumothorax. Sensitivity, specificity, negative (npv) and positive predictive value (ppv) as well as the positive (LR+) and negative likelihood ratio (LR-) were determined in a blinded randomized interobserver study with 116 patients. The evaluation was performed by three board-certified radiologists. Results: In 131 patients, there were 139 pneumothoraces, 135 (97.1 %) were located apical, 88 (63.3 %) lateral and 33 (23.7 %) basal. Sensitivity was 99 % for inspiratory and 97 % for expiratory radiographs. The interobserver study yielded a mean sensitivity of 86.1 %/86.1 %, specificity of 97.3 %/93.4 %, npv of 88.7 %/88.5 % and ppv of 96.7 %/92.1 % for inspiration/expiration. For inspiratory radiographs the LR+/LR-were 40.2/0.14 and for expiration 13.9 and 0.15. McNemar-Test showed no significant difference for the detection of pneumothoraces in in-/exspiration. Conclusion: Inspiratory and expiratory digital radiographs are equally suitable for pneumothorax detection. Inspiratory radiographs are recommended as the initial examination of choice for pneumothorax detection, an additional expiratory radiograph is only recommended in doubtful cases.

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supporting

confidence: 91%

supporting

confidence: 86%

Section: Patient Selection and Study Populationmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Value of Digital Radiography in Expiration in Detection of Pneumothorax

Thomsen

Natho

Feigen

et al. 2013

Fortschr Röntgenstr

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Evaluation and Management of Patients with Chest Syndromes

Harrigan¹,

DeAngelis²

2007

Emergency Medicine: Avoiding the Pitfalls and Improving the Outcomes

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Table 1.1 Risk factors for painless acute MI [1]. Risk Factors % Without Chest Pain Prior heart failure 51 Prior stroke 47 Age Ͼ 75 years 45 Diabetes mellitus 38 Non-white 34 Women 39 1. QRS complex width Ͼ 0.12 s; 2. broad QS or rS pattern in the right precordial leads (leads V1, V2, and sometimes V3); KEY FACT | 7% of patients with acute MI or unstable angina had their pain partially or fully reproduced on chest wall palpation. KEY FACT | Sinus tachycardia was found in only 8-69% of patients (with PE). KEY FACT | The presence of pleurisy is neither sensitive nor specific for PE. In one study … pleuritic chest pain occurred in only 44% of patients with PE versus 30% of patients without PE.

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Pleural Disease

Light¹

2005

Evidence‐based Respiratory Medicine

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Comparison of upright inspiratory and expiratory chest radiographs for detecting pneumothoraces.

Cited by 71 publications

References 4 publications

Value of Digital Radiography in Expiration in Detection of Pneumothorax

Value of Digital Radiography in Expiration in Detection of Pneumothorax

Evaluation and Management of Patients with Chest Syndromes

Pleural Disease

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