The Sonographic Detection of Pneumothoraces

  • A. W. Kirkpatrick
  • S. Nicolaou


Pneumothoraces remain a preventable cause of death, not only following traumatic injury, but also after therapeutic, and diagnostic procedures. Large or symptomatic pneumothoraces should be diagnosed with a thorough physical examination. Physical findings, which may reveal the pneumothorax include; diminished breath sounds on auscultation, hyperresonance on percussion, or distended neck veins and tracheal deviation. The evolution of a tension pneumothorax is dynamic though, and often patients must either be transported in vehicles or committed to an operative position in which timely access to the chest is restricted. In order to diagnose less obvious pneumothoraces in a timely fashion, clinicians have stressed obtaining an anteroposterior supine chest X-ray as early as possible in the resuscitative process. The radiologic findings associated with pneumothoraces in a supine positioned patient (deep sulcus sign, continuous hemidiaphragm sign, sharp delineation of the pericardial silhouette, asymmetric lucency of the hemithorax on the side of the pneumothorax) lack sensitivity, (50 to 70% in certain series when compared to computed tomography). Thus, there is merit in exploring other diagnostic modalities.


Pleural Fluid Pleural Space Reverberation Artifact Thoracic Ultrasound Comet Tail Artifact 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Selected References

  1. Boulanger BR, Kearney PA, Brenneman FD, Tsuei B, Ochoa J. FAST utilization in 1999: Result of a survey of North American trauma centers. Am Surg 2000;66:1049–55.PubMedGoogle Scholar
  2. Boulanger BR, McLellan BA, Brenneman FD. The indeterminate abdominal sonogram in multi-system blunt trauma. J Trauma 1998;45:52.PubMedCrossRefGoogle Scholar
  3. Cunningham J, Kirkpatrick AW, Nicolaou S, Liu D, Hamilton DR, Lawless B, Lee M, Brown DR, Simons RK. Enhanced recognition of “lung sliding” with power color Doppler imaging in the diagnosis of pneumothorax. J Trauma in press.Google Scholar
  4. Dulchavsky SA, Hamilton DR, Diebel LN, Sargsyan AE, Billica RD, Williams DR. Thoracic ultrasound diagnosis of pneumothorax. J Trauma 1999;47:970–1.PubMedCrossRefGoogle Scholar
  5. Dulchavsky SA, Schwarz KW, Kirkpatrick AW, Billica RD, Williams DR, Diebel LN, Campbell MR, Sargsyan AE, Hamilton DR. Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. J Trauma 2001;50:201–5.PubMedCrossRefGoogle Scholar
  6. Goodman TR, Traill ZC, Phillips AJ, Berger J, Gleeson FV. Ultrasound detection of pneumothorax. Clin Radiol 1999;54:736–9.PubMedCrossRefGoogle Scholar
  7. Kirkpatrick AW, Ng A, Dulchavsky SA, Lyburn I, Harris A, Torregianni W, Simons RK, Nicolaou S. Sonographic diagnosis of a pneumothorax inapparent on plain chest radiography: Confirmation by Computed Tomography. J Trauma 2001;50:750–2.PubMedCrossRefGoogle Scholar
  8. Lichtenstein D, Meziere G, Biderman P, Gepner A. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 1999;25:383–8.PubMedCrossRefGoogle Scholar
  9. Lichtenstein D, Meziere G, Biderman P, Gepner A, Barre O. The comet tail artifact: An ultrasound sign of alveolar-interstitial syndrome. Am J Resp Crit Care Med 1997;156:1640–6.PubMedGoogle Scholar
  10. Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill: Lung sliding. Chest 1995;108:1345–8.PubMedCrossRefGoogle Scholar
  11. Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med 1997;29:312–6.PubMedCrossRefGoogle Scholar
  12. Neff MA, Monk JS, Peters K, Nikhilesh A. Detection of occult pneumothoraces on abdominal computed scans in trauma patients. J Trauma 2000;49:281–5.PubMedCrossRefGoogle Scholar
  13. Ratanen NW. Diagnostic ultrasound: diseases of the thorax. Vet Clin N Amer 1986;2:49–66.Google Scholar
  14. Rozycki GS, Pennington SD, Feliciano DV. Surgeon-performed ultrasound in the critical care setting: It’s use as an extension of the physical examination to detect pleural effusion. J Trauma 2001;50:636–42.PubMedCrossRefGoogle Scholar
  15. Sisley A, Rozycki G, Ballard R, Namias N, Salomone JP, Feliciano DV. Rapid detection of traumatic effusion using surgeon-performed ultrasound. J Trauma 1998;44:291–7.PubMedCrossRefGoogle Scholar
  16. Sistrom CL, Reiheld CT, Spencer BG, Wallace KK. Detection and estimation of the volume of pneumothorax using real-time sonography. AJR 1996;166:317–21.PubMedGoogle Scholar
  17. Targhetta R, Bourgeois JM, Chavagneux R, Balmes P. Diagnosis of pneumothorax by ultrasound immediately after ultrasonically guided aspiration biopsy. Chest 1992;101:855–6.PubMedCrossRefGoogle Scholar
  18. Targhetta R, Bourgeois JM, Chavagneux R, Mart-Double C, Balmes P. Ultrasonographic approach to diagnosing hydropneumothorax. Chest 1992;101:931–4.PubMedCrossRefGoogle Scholar
  19. Wernecke K, Galanski M, Peters PE, Hansen J. Pneumothorax: evaluation by ultrasound-preliminary results. J Thorac Imag 1987;2:76–8.CrossRefGoogle Scholar

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© Springer Science+Business Media New York 2002

Authors and Affiliations

  • A. W. Kirkpatrick
  • S. Nicolaou

There are no affiliations available

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