Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis

Abstract

IntroductionUltrasonography is being increasingly utilized in acute care settings with expanding applications. Pneumothorax evaluation by ultrasonography is a fast, safe, easy and inexpensive alternative to chest radiographs. In this review, we provide a comprehensive analysis of the current literature comparing ultrasonography and chest radiography for the diagnosis of pneumothorax.MethodsWe searched English-language articles in MEDLINE, EMBASE and Cochrane Library dealing with both ultrasonography and chest radiography for diagnosis of pneumothorax. In eligible studies that met strict inclusion criteria, we conducted a meta-analysis to evaluate the diagnostic accuracy of pleural ultrasonography in comparison with chest radiography for the diagnosis of pneumothorax.ResultsWe reviewed 601 articles and selected 25 original research articles for detailed review. Only 13 articles met all of our inclusion criteria and were included in the final analysis. One study used lung sliding sign alone, 12 studies used lung sliding and comet tail signs, and 6 studies searched for lung point in addition to the other two signs. Ultrasonography had a pooled sensitivity of 78.6% (95% CI, 68.1 to 98.1) and a specificity of 98.4% (95% CI, 97.3 to 99.5). Chest radiography had a pooled sensitivity of 39.8% (95% CI, 29.4 to 50.3) and a specificity of 99.3% (95% CI, 98.4 to 100). Our meta-regression and subgroup analyses indicate that consecutive sampling of patients compared to convenience sampling provided higher sensitivity results for both ultrasonography and chest radiography. Consecutive versus nonconsecutive sampling and trauma versus nontrauma settings were significant sources of heterogeneity. In addition, subgroup analysis showed significant variations related to operator and type of probe used.ConclusionsOur study indicates that ultrasonography is more accurate than chest radiography for detection of pneumothorax. The results support the previous investigations in this field, add new valuable information obtained from subgroup analysis, and provide accurate estimates for the performance parameters of both bedside ultrasonography and chest radiography for pneumothorax evaluation.

The efficacy of bedside chest ultrasound: from accuracy to outcomes

“…The accuracy of ultrasound for pneumothorax diagnosis has been compared to chest radiography (table 2) in four meta-analyses [24,[27][28][29]. Pooled ultrasound sensitivity was 78-90% and pooled specificity was >98% [24,[27][28][29].…”

Uso de ecografía en anestesia: Point of Care Ultrasound (POCUS)

“…Un metaanálisis de Alrajab y cols., muestra una sensibilidad global de 39,8% para la radiografía de tórax y de 78,6% para el US 17 . Por ello, tras realizar una punción venosa central dificultosa, o cuando hay sospecha de haber tenido un barotrauma, el uso del ecógrafo permite rápidamente diagnosticar el problema sin tener que esperar una radiografía portátil o un traslado a rayos.…”

Ultrasonido en el punto de atención en un escenario rural con recursos limitados

“…Ultrasonido de pulmón El ultrasonido ha demostrado sensibilidad igual o superior a la radiografía convencional en el diagnóstico de diversas entidades y permite la evaluación enfocada de patologías agudas graves como derrame pleural (70) , neumonías (16,71,72) , falla cardiaca (44) , neumotórax (73) , hemotórax (60) .…”