Lichtenstein D, Mezière G, Biderman P, Gepner A
Service de Réanimation Médicale, Hôpital Ambroise Paré, Boulogne (Paris), France.
Intensive Care Med. 1999 Apr;25(4):383-8. doi: 10.1007/s001340050862.
Ultrasound artifacts arising from the lung-wall interface are either vertical (comet-tail artifacts) or horizontal. The significance of these artifacts for the diagnosis of pneumothorax was assessed.
Prospective clinical study.
The medical ICU of a university-affiliated teaching hospital.
We compared 41 complete pneumothoraces with 146 hemithoraces in 73 critically ill patients in which computed tomography showed absence of pneumothorax.
The anterior chest wall was investigated in supine patients using a portable device. The test was defined as positive for complete pneumothorax when only horizontal artifacts were visible, and negative when artifacts arising from the pleural line and spreading up to the edge of the screen (referred to as "comet-tail artifacts") were present.
The feasibility was 98%. Ultrasound showed exclusive horizontal artifacts in all 41 analyzable cases of complete pneumothorax. In the pneumothorax-free group, "comet-tail artifacts" were present in 87 cases and exclusive horizontal artifacts in 56. Ultrasound as well as computed tomography showed anterior consolidation or anterior pleural effusion in three cases. Horizontal artifacts had a sensitivity and a negative predictive value of 100% and a specificity of 60% for the diagnosis of pneumothorax. Horizontal artifacts and absent lung sliding, when combined, had a sensitivity and a negative predictive value of 100% and a specificity of 96.5%.
Ultrasound detection of the "comet-tail artifact" at the anterior chest wall allows complete pneumothorax to be discounted.
由肺-胸壁界面产生的超声伪像要么是垂直的(彗尾伪像),要么是水平的。评估这些伪像对气胸诊断的意义。
前瞻性临床研究。
一所大学附属医院的医学重症监护病房。
我们比较了73例危重症患者中的41例完全性气胸与146个半侧胸腔,这些患者的计算机断层扫描显示无气胸。
使用便携式设备对仰卧位患者的前胸壁进行检查。当仅可见水平伪像时,该检查被定义为完全性气胸阳性;当存在起源于胸膜线并延伸至屏幕边缘的伪像(称为“彗尾伪像”)时,则为阴性。
可行性为98%。超声在所有41例可分析的完全性气胸病例中均显示出单纯的水平伪像。在无气胸组中,87例出现“彗尾伪像”,56例出现单纯的水平伪像。超声和计算机断层扫描在3例中均显示前胸实变或胸腔积液。水平伪像对气胸诊断的敏感性和阴性预测值为100%,特异性为60%。水平伪像与肺滑动消失相结合时,敏感性和阴性预测值为100%,特异性为96.5%。
在前胸壁超声检测到“彗尾伪像”可排除完全性气胸。