Quarato Carla Maria Irene, Mirijello Antonio, Bocchino Marialuisa, Feragalli Beatrice, Lacedonia Donato, Rea Gaetano, Lieto Roberta, Maggi Michele, Hoxhallari Anela, Scioscia Giulia, Vicario Aldo, Pellegrino Giuseppe, Pazienza Luca, Villani Rosanna, Bellanova Salvatore, Bracciale Pierluigi, Notarangelo Stefano, Morlino Paride, De Cosmo Salvatore, Sperandeo Marco
Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario "Riuniti" di Foggia, University of Foggia, 71122 Foggia, Italy.
Department of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy.
J Clin Med. 2024 Aug 17;13(16):4861. doi: 10.3390/jcm13164861.
: Pneumothorax (PNX) represents a common clinical condition in emergency departments (EDs), requiring prompt recognition and treatment. The role of transthoracic ultrasounds (TUSs) in the diagnosis of PNX is still debated. We aimed to prospectively evaluate the accuracy of TUSs in the detection of spontaneous PNX in EDs. : A total of 637 consecutive adult patients who presented to the EDs of four Italian hospitals complaining of acutely onset chest pain and dyspnoea were included in the study. Exclusion criteria were previous traumatic events, cardiogenic causes of pain/dyspnoea and suspected tension PNX. The absence of "lung sliding" (B-mode) and the "bar-code" sign (M-mode) were considered indicative of PNX in a TUS. Accuracy, sensitivity, specificity, and positive and negative predictive values (PPVs, NPVs) were calculated using a chest CT scan as reference. : Spontaneous PNX occurred in 93 patients: of those, 83 (89.2%) were correctly identified by TUSs. However, 306 patients with suspected PNX at TUS were not confirmed by chest CTs. The diagnostic accuracy of both the absence of "lung sliding" and "bar-code" sign during TUS was 50.4% (95% CI: 46.4-54.3), sensitivity was 89.2% (95% CI: 81.1-94.7), specificity was 43.8% (95% CI: 39.5-48.0), the PPV was 21.3% (95% CI: 19.7-23.1) and the NPV was 96.0% (95% CI: 92.9-97.7). : TUS showed high sensitivity but low specificity in the identification of PNX in EDs. Relying exclusively on TUSs results for patients' management in ED settings is neither suitable nor recommendable. TUS examination can be useful to strengthen the clinical suspicion of PNX, but its results should be confirmed by a chest X-ray or CT scan.
气胸（PNX）是急诊科常见的临床病症，需要及时识别和治疗。经胸超声检查（TUSs）在气胸诊断中的作用仍存在争议。我们旨在前瞻性评估经胸超声检查在急诊科检测自发性气胸的准确性。
本研究纳入了意大利四家医院急诊科连续就诊的637例成年患者，这些患者均主诉急性胸痛和呼吸困难。排除标准包括既往创伤史、疼痛/呼吸困难的心源病因以及疑似张力性气胸。经胸超声检查中，“肺滑动征”（B超模式）缺失和“条形码征”（M超模式）缺失被视为气胸的指征。以胸部CT扫描为参考，计算准确性、敏感性、特异性以及阳性和阴性预测值（PPV、NPV）。
93例患者发生自发性气胸：其中，经胸超声检查正确识别出83例（89.2%）。然而，306例经胸超声检查疑似气胸的患者经胸部CT检查未得到证实。经胸超声检查时“肺滑动征”和“条形码征”缺失的诊断准确性为50.4%（95%置信区间：46.4 - 54.3），敏感性为89.2%（95%置信区间：81.1 - 94.7），特异性为43.8%（95%置信区间：39.5 - 48.0），阳性预测值为21.3%（95%置信区间：19.7 - 23.1），阴性预测值为96.0%（95%置信区间：92.9 - 97.7）。
经胸超声检查在急诊科识别气胸时显示出高敏感性但低特异性。在急诊科仅依靠经胸超声检查结果进行患者管理既不合适也不可取。经胸超声检查有助于强化对气胸的临床怀疑，但检查结果应通过胸部X线或CT扫描予以证实。
