Ultrasound guiding the rapid diagnosis and treatment of perioperative pneumothorax: A case report

Abstract

BACKGROUND Pneumothorax is one of the most common causes of acute dyspnea. In patients under general anesthesia, the symptoms may not be obvious, which may delay diagnosis and treatment. Computed tomography is the gold standard for the diagnosis of pneumothorax, but is not suitable for rapid diagnosis of this complication. In contrast, lung ultrasonography can provide rapid diagnosis and treatment of pneumothorax. CASE SUMMARY The patient was a 53-year-old man admitted for rupture of the spleen caused by an accidental fall and emergency splenectomy was planned. Anesthesia was induced, and tracheal intubation was performed successfully with a video laryngoscope. About 2 min after tracheal intubation, the airway peak pressure increased to 50 cm H 2 O and the oxygen saturation dropped to 70%. According to the BLUE protocol, a recommended area of the chest was scanned by ultrasound. The pleural slide sign disappeared and obvious parallel line sign could be seen in the left lung. The boundary of pneumothorax (lung points) were rapidly confirmed by ultrasound. To avoid lung injury, a closed thoracic drainage tube was placed in the involved area. On day 9 after surgery, the patient was discharged from the hospital without any complications. CONCLUSION Perioperative pneumothorax is rare but dangerous. It can be rapidly diagnosed and treated with ultrasound guidance.

Confiabilidad del ultrasonido para diagnóstico de neumotórax

“…Por ejemplo, De la peña et al ( 2021) reportan un caso de neumotórax en un paciente con diagnóstico de neumonía secundaria a SARS-Cov-2 que fué sometido a ventilación mecanica, en donde dicha patología fué diagnósticada usando ultrasonido, concluyendo que el US es una excelenta herramienta que se debe considerar en el diagnóstico de múltiples condiciones clínicas, especialmente neumotórax. Zhang et al (2021) reportan el caso de un paciente con neumotórax perioperatorio que fué rápidamente diagnósticado con ultrasonido, donde refieren que aunque la TC sea el gold estandar, el diagnóstico por US puede ser más rápido favoreciendo de esta manera el tratamiento y evolución del paciente.…”

The Role of Pocus in Acute Respiratory Failure: A Narrative Review on Airway and Breathing Assessment

“…They are mainly observational and sistematic review, only three are randomised controlled trial (Table 3). [29] The Netherlands Case report 1 Staub LJ et al, 2019 [30] Brazil Systematic review and meta-analysis Chavez MA et al, 2014 [31] Perù Systematic review and meta-analysis Alzahrani, S.A [32] Saudi Arabia Sistematic review Grabala J et al, 2020 [33] Poland Case study 1 Gardecki J et al, 2019 [34] USA Case study 1 Pneumothorax (PNX) Lichtenstein DA et al, 2005 [35] France Observational study 200 Zhang G et al, 2021 [36] China Case report 1…”

“…While LUS demonstrated good reliability in diagnosing PNX and it is easily deployable by emergency physicians in clinical practice [36], clinicians should exercise caution and always correlate clinical presentation to avoid misinterpretation of US findings. Other factors, such as hypercapnia and BMI in patients with COPD and asthma, as well as pneumothorax or pleural talcage, can contribute to the loss of lung sliding [37].…”

Diagnostic Potentials of Lung Ultrasound In Neonatal Care: An Updated Overview

“…Among these are the benefits of obtaining real-time dynamic assessments of conditions of the lung without ionizing radiations, management of frail neonates, and ensuring safety throughout the process. According to Husain et al, it is extra sensitive to small disease changes and therefore helps in early management [21]. It was noted as an effective modality in detecting and localizing pneumothorax with better accuracy when compared to conventional chest X-rays.…”