Matsumoto Shokei, Sekine Kazuhiko, Funabiki Tomohiro, Orita Tomohiko, Shimizu Masayuki, Hayashida Kei, Kazamaki Taku, Suzuki Tatsuya, Kishikawa Masanobu, Yamazaki Motoyasu, Kitano Mitsuhide
Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama-shi, Kanagawa 230-0012 Japan.
Department of Emergency Medicine, Saiseikai Central Hospital, 1-4-17 Mita, Minato, Tokyo, 108-0073 Japan.
World J Emerg Surg. 2016 Jan 13;11:5. doi: 10.1186/s13017-016-0061-x. eCollection 2016.
An occult pneumothorax is a pneumothorax that is not seen on a supine chest X-ray but is detected by computed tomography scanning. However, critical patients are difficult to transport to the computed tomography suite. We previously reported a method to detect occult pneumothorax using oblique chest radiography (OXR). Several authors have also reported that ultrasonography is an effective technique for detecting occult pneumothorax. The aim of this study was to evaluate the usefulness of OXR in the diagnosis of the occult pneumothorax and to compare OXR with ultrasonography.
All consecutive blunt chest trauma patients with clinically suspected pneumothorax on arrival at the emergency department were prospectively included at our tertiary-care center. The patients underwent OXR and ultrasonography, and underwent computed tomography scans as the gold standard. Occult pneumothorax size on computed tomography was classified as minuscule, anterior, or anterolateral.
One hundred and fifty-nine patients were enrolled. Of the 70 occult pneumothoraces found in the 318 thoraces, 19 were minuscule, 32 were anterior, and 19 were anterolateral. The sensitivity and specificity of OXR for detecting occult pneumothorax was 61.4 % and 99.2 %, respectively. The sensitivity and specificity of lung ultrasonography was 62.9 % and 98.8 %, respectively. Among 27 occult pneumothoraces that could not be detected by OXR, 16 were minuscule and 21 could be conservatively managed without thoracostomy.
OXR appears to be as good method as lung ultrasonography in the detection of large occult pneumothorax. In trauma patients who are difficult to transfer to computed tomography scan, OXR may be effective at detecting occult pneumothorax with a risk of progression.
隐匿性气胸是指在仰卧位胸部X线片上未显示，但通过计算机断层扫描检测到的气胸。然而，重症患者难以转运至计算机断层扫描室。我们之前报道了一种使用胸部斜位X线摄影（OXR）检测隐匿性气胸的方法。几位作者也报道超声检查是检测隐匿性气胸的有效技术。本研究的目的是评估OXR在隐匿性气胸诊断中的实用性，并将OXR与超声检查进行比较。
在我们的三级医疗中心，前瞻性纳入所有在急诊科就诊时临床怀疑气胸的连续钝性胸部创伤患者。患者接受OXR和超声检查，并以计算机断层扫描作为金标准。计算机断层扫描显示的隐匿性气胸大小分为微小、前部或前外侧。
共纳入159例患者。在318侧胸廓中发现70例隐匿性气胸，其中19例为微小气胸，32例为前部气胸，19例为前外侧气胸。OXR检测隐匿性气胸的敏感性和特异性分别为61.4%和99.2%。肺部超声检查的敏感性和特异性分别为62.9%和98.8%。在27例OXR未能检测到的隐匿性气胸中，16例为微小气胸，21例可保守治疗而无需胸腔造口术。
在检测大型隐匿性气胸方面，OXR似乎是与肺部超声检查一样好的方法。对于难以转运至计算机断层扫描的创伤患者，OXR可能有效地检测出有进展风险的隐匿性气胸。
