Reissig A, Kroegel C
Pneumologie & Allergologie/Immunologie, Klinik Innere Medizin I der Friedrich-Schiller-Universität Jena.
Praxis (Bern 1994). 2006 Apr 19;95(16):617-24. doi: 10.1024/0369-8394.95.16.617.
In order to answer the question, if transthoracic sonography may replace chest radiographs in diagnosing post-interventional pneumothorax/hydropneumothorax, this prospective study was conducted. A total of 100 patients (38 females, 62 males; median age 63 years), biopsy and 37 had an ultrasound-guided tube thoracostomy, were enrolled in the study. Transthoracic sonography was performed three hours after the intervention, followed by postero-anterior chest radiograph. One (1%) of the 100 patients developed a pneumothorax after transbronchial biopsy. Eight of 37 patients suffered from hydropneumothorax due to tube thoracostomy detected by sonography. In one patient, hydropneumothorax was missed by posteroanterior chest radiography. Sensitivity, specificity and accuracy of transthoracic sonography were 100%. Transthoracic sonography is a safe bed-side-method, allowing an immediate exclusion/diagnosis of postinterventional pneumothorax/hydropneumothorax. The results suggest that chest radiography may only be required in patients with pneumothorax diagnosed by transthoracic sonography so as to assess its extension, if full sonographic assessment is not possible or if any discrepancy exists between TS-results and clinical presentation.
为了回答经胸超声检查是否可以替代胸部X线片来诊断介入治疗后气胸/液气胸这一问题,我们开展了这项前瞻性研究。共有100例患者(38例女性,62例男性;中位年龄63岁)纳入研究,其中进行活检的患者有37例接受了超声引导下胸腔置管引流术。介入治疗3小时后进行经胸超声检查,随后拍摄后前位胸部X线片。100例患者中有1例(1%)在经支气管活检后发生气胸。37例患者中有8例因胸腔置管引流术导致液气胸,经超声检查发现。1例患者的液气胸在后前位胸部X线片检查中漏诊。经胸超声检查的敏感性、特异性和准确性均为100%。经胸超声检查是一种安全的床旁检查方法,可立即排除/诊断介入治疗后气胸/液气胸。结果表明,如果经胸超声检查无法进行全面评估,或者经胸超声检查结果与临床表现存在差异,那么可能仅需对经胸超声检查诊断为气胸的患者进行胸部X线片检查,以评估气胸的范围。