Study of the role of ultrasonography in blunt chest trauma

ABSTRACT

The purpose of this investigation was to evaluate the role of thoracic ultrasound for detection of hemopneumothorax and pericardial collection and treatment in patients with blunt chest trauma. This study included 50 patients admitted to Emergency department in alexandria university hospital presented with isolated blunt chest trauma or polytrauma with chest involvement, their age ranged from 16-80 years, 88% of them were males and 12% were females, males are more than females because they are more active & physically more mobile.  In our study chest computed tomography was used as a gold standard for diagnosing hemothorax, pneumothorax, pericardial effusion & lung contusion to assess the diagnostic value of chest radiography and lung ultrasonography. This study shows Sensitivity, specificity and accuracy of US & x ray in detecting hemothorax , for US chest Sensitivity was 95.24% , Specificity was 100.0% , PPV was 100.0% , NPV 96.67% & Accuracy was 98.0% compared to chest x -ray Sensitivity was 71.43, Specificity was 100.0% , PPV was 100.0% , NPV 82.86% & Accuracy was 88.0% , For pneumothorax ; US chest Sensitivity was 82.76% , Specificity was 100.0% , PPV was 100.0% , NPV 81.48% & Accuracy was 90.2% compared to chest x -ray Sensitivity was 71.43, Specificity was 100.0% , PPV was 100.0% , NPV 73.33% & Accuracy was 84.0% . For lung contusion ; US chest Sensitivity was 82.61% , Specificity was 100.0% , PPV was 100.0% , NPV 87.50% & Accuracy was 92.16% compared to chest x -ray Sensitivity was 50.0, Specificity was 100.0% , PPV was 100.0% , NPV 71.79% & Accuracy was 78.0. For pericardial effussion ;  US chest Sensitivity was 100.0% , Specificity was 100.0% , PPV was 100.0% , NPV 100.0% & Accuracy was 100.0% compared to chest x -ray Sensitivity was 0%, Specificity was 100.0% , PPV was 0% , NPV 94.0% & Accuracy was 94.0% .

Key words: Thoracic injuries, blunt cardiac injuries, thoracic trauma

REFERENCES

1. Park K: Accidents. In Textbook of Social and Preventive Medicine. 17 edition. Edited by: Park K. Jabalpur: Banarsidas Co; 2000:304-5.
2. Miller DL, Mansour KA: Blunt traumatic chest injuries. Thoracic Surgery Clinics 2007; 17:57-61.
3. Kivioja AH, Myllynenn PJ, Rokkanen PU: Is the treatment of the most severe multiply injured patients worth the effort? J Trauma 1990; 30: 480.
4. Clancy TV, Maxwell JG, Covington DL. A statewide analysis of level I and level II trauma centers for the patients with major injuries. J Trauma. 2001; 51: 346-51.
5. Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of haemothorax. Ann Emerg Med 1997; 29:312–6.
6. Blaivas M, DeBehnke D, Phelan MB. Potential errors in the diagnosis of pericardial effusion on trauma ultrasound for penetrating injuries. Acad Emerg Med 2000; 7:1261–6.
7. Nandipati KC, Allamaneni S, Kakarla R, et al. Extended focused assessment with sonography for trauma (EFAST) in the diagnosis of pneumothorax: experience at a community based level I trauma center. Injury 2010;41:862–865.
8. American College of Emergency Physicians. Emergency ultrasound guidelines – 2008. Ann Emerg Med. 2009; 53:550-570.
9. Rothlin MA, Naf R, Amgwerd M, Candinas D, Frick T, Trentz O. Ultrasound in blunt abdominal and thoracic trauma. J Trauma 1993; 34: 488-95.
10. Dulchavsky SA, Schwarz KL, Kirkpatrick AW, Billica RD, Williams DR, Diebel LN, et al. Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. J Trauma 2001; 50: 201-5.   
11. Symbas NP, Bongiorno PF, Symbas PN. Blunt cardiac rupture: the utility of emergency department ultrasound. Ann Thorac Surg 1999; 67: 1274-6.
12. Lichtenstein D, Lascols N, Mezière G, Gepner A. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intens Care Med 2004; 30: 276-81.
13. Ugalde, P., Camargo, J. D. J., & Deslauriers, J. (2007 November) Lobes, Fissures, and Bronchopulmonary Segments. 17 (4), 587-599.
14. Feller-Kopman D. Ultrasound-guided thoracentesis. Chest. 2006;129:1709-14.
15. Ferreira AC. The role of ultrasound in the assessment of pleural effusion. Radiol Bras.  2006;39:145-50.
16. Yu CJ, Yang PC, Wu HD. Ultrasound study in unilateral hemithorax opacification. Image comparison with computed tomography. Am Rev Respir Dis. 1993;147:430-34.