Ultrasonographic Diagnosis of Suspected Hemopneumothorax in Trauma Patients

Abstract

Background:Bleeding and trapped air in the pleural space are called hemothorax and pneumothorax, respectively. In cases where there are delays in diagnosis and treatment, the mortality rates due to hemopneumothorax can be significant. Hemopneumothorax is characterized by decreased lung sounds or chest percussion and subcutaneous emphysema. Diagnosis of pneumothorax and hemothorax can be achieved by portable chest X-ray (CXR), computed tomography (CT) scan, or ultrasonography. Portable CXR and CT-scans have their individual drawbacks. CXR creates a high percentage of false negative results, and a CT-scan is time consuming and less cost-effective; in addition, both modalities expose patients to radiation. Therefore, the introduction of ultrasonography as an easily available and highly accurate diagnostic modality has particular importance.Objectives:The aim of this study was to evaluate the sensitivity and specificity of ultrasonography in the diagnosis of pneumothorax and hemothorax in comparison with the other two methods, namely portable CXR and CT-scan.Patients and Methods:Patients (163) with multiple trauma who were suspected of having chest injuries, and who had indications for a chest CT-scan according to ATLS algorithms, were included in the study. All patients underwent portable CXR, CT-scan, and ultrasonography.Results:In total, 163 patients were included in this study; 29 patients had a pneumothorax, 24 patients had a hemothorax, and 23 patients had a hemopneumothorax confirmed. The study revealed that ultrasonography had a sensitivity of 96.15%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 98%, in the diagnosis of pneumothorax. The sensitivity for ultrasonography in the diagnosis of a hemothorax was 82.97%, with a specificity of 98.05%, a positive predictive value of 90%, and a negative predictive value of 92.66%. Portable CXR for pneumothorax detection had a sensitivity of 34.61%, a specificity of 97.95%, a positive predictive value of 90%, and a negative predictive value of 73.84%. In the detection of hemothorax, CXR had a sensitivity of 25.53%, a specificity of 95.14%, a positive predictive value of 70.58%, and a negative predictive value of 73.68%.Conclusions:Ultrasonography sensitivity and specificity for diagnosis of hemopneumothorax was high. The sensitivity of portable CXR was low despite its high specificity for the detection of hemothorax and pneumothorax.

Blunt abdominal trauma and organ damage and its prognosis

“…8,13 Ultrasound is an early diagnostic method to detect free fluid in the abdomen and pelvic cavity. 6,[14][15][16] Emergency physicians may request CT, DPL, and laparotomy id needed. 11,17 Surgery or nonsurgical management depends on the patient's condition, the damage pattern and the availability of surgeons.…”

Evaluation of three phases computed tomography scan findings in blunt abdominal trauma

“…Also ultrasonography is the safest and easiest modality for evaluation of trauma patients and can done by emergency physicians and even it can be used to find pneumothorax and hemothorax. 11,12 CT scan is one of the best methods for evaluating patients with blunt abdominal trauma. 13 In present study we evaluated three phases CT scan report of 290 patients with blunt abdominal trauma.…”

Assessment of Shift Programs of Emergency Department Health Personnel in Four Hospitals Providing Medical Training in Turkey and Iran, A Brief Report

“…A survey carried out among emergency medicine Residents in the US reported that 73% of participants preferred 8-and 10 -h shifts, while 21% preferred 12 -h shifts (14). Although these shifts design can increase or decrease burnout possibility, the emergency medicine residents and specialist can easily perform all procedures in the emergency department perfectly and can also decrease the length of stay and make disposition rapidly (15)(16)(17)(18)(19).…”