The Sonographic Detection of Pneumothoraces
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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.
KeywordsPleural Fluid Pleural Space Reverberation Artifact Thoracic Ultrasound Comet Tail Artifact
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