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World Journal of Emergency Surgery

Open Access 01-12-2016 | Research article

Diagnostic accuracy of oblique chest radiograph for occult pneumothorax: comparison with ultrasonography

Authors: Shokei Matsumoto, Kazuhiko Sekine, Tomohiro Funabiki, Tomohiko Orita, Masayuki Shimizu, Kei Hayashida, Taku Kazamaki, Tatsuya Suzuki, Masanobu Kishikawa, Motoyasu Yamazaki, Mitsuhide Kitano

Published in: World Journal of Emergency Surgery | Issue 1/2016

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Abstract

Backgraound

An occult pneumothorax is a pneumothorax that is not seen on a supine chest X-ray but is detected by computed tomography scanning. However, critical patients are difficult to transport to the computed tomography suite. We previously reported a method to detect occult pneumothorax using oblique chest radiography (OXR). Several authors have also reported that ultrasonography is an effective technique for detecting occult pneumothorax. The aim of this study was to evaluate the usefulness of OXR in the diagnosis of the occult pneumothorax and to compare OXR with ultrasonography.

Methods

All consecutive blunt chest trauma patients with clinically suspected pneumothorax on arrival at the emergency department were prospectively included at our tertiary-care center. The patients underwent OXR and ultrasonography, and underwent computed tomography scans as the gold standard. Occult pneumothorax size on computed tomography was classified as minuscule, anterior, or anterolateral.

Results

One hundred and fifty-nine patients were enrolled. Of the 70 occult pneumothoraces found in the 318 thoraces, 19 were minuscule, 32 were anterior, and 19 were anterolateral. The sensitivity and specificity of OXR for detecting occult pneumothorax was 61.4 % and 99.2 %, respectively. The sensitivity and specificity of lung ultrasonography was 62.9 % and 98.8 %, respectively. Among 27 occult pneumothoraces that could not be detected by OXR, 16 were minuscule and 21 could be conservatively managed without thoracostomy.

Conclusion

OXR appears to be as good method as lung ultrasonography in the detection of large occult pneumothorax. In trauma patients who are difficult to transfer to computed tomography scan, OXR may be effective at detecting occult pneumothorax with a risk of progression.
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Metadata
Title
Diagnostic accuracy of oblique chest radiograph for occult pneumothorax: comparison with ultrasonography
Authors
Shokei Matsumoto
Kazuhiko Sekine
Tomohiro Funabiki
Tomohiko Orita
Masayuki Shimizu
Kei Hayashida
Taku Kazamaki
Tatsuya Suzuki
Masanobu Kishikawa
Motoyasu Yamazaki
Mitsuhide Kitano
Publication date
01-12-2016
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2016
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-016-0061-x