Ultrasonographic Diagnosis of Suspected Hemopneumothorax in Trauma Patients

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 (۱۶۳) 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, ۱۶۳ patients were included in this study; ۲۹ patients had a pneumothorax, ۲۴ patients had a hemothorax, and ۲۳ patients had a hemopneumothorax confirmed. The study revealed that ultrasonography had a sensitivity of ۹۶.۱۵%, a specificity of ۱۰۰%, a positive predictive value of ۱۰۰%, and a negative predictive value of ۹۸%, in the diagnosis of pneumothorax. The sensitivity for ultrasonography in the diagnosis of a hemothorax was ۸۲.۹۷%, with a specificity of ۹۸.۰۵%, a positive predictive value of ۹۰%, and a negative predictive value of ۹۲.۶۶%. Portable CXR for pneumothorax detection had a sensitivity of ۳۴.۶۱%, a specificity of ۹۷.۹۵%, a positive predictive value of ۹۰%, and a negative predictive value of ۷۳.۸۴%. In the detection of hemothorax, CXR had a sensitivity of ۲۵.۵۳%, a specificity of ۹۵.۱۴%, a positive predictive value of ۷۰.۵۸%, and a negative predictive value of ۷۳.۶۸%. 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.

Keywords:

Pneumothorax , hemothorax , Trauma