We know ultrasound is great for detecting pneumothorax, there’s been lots of studies confirming this, and here’s the final meta-analysis from Chest – print it and use it to slap colleagues who still want x-rays over ultrasound scans.
This was a systematic review of trials on ultrasound vs supine x-ray for detecting pneumothoraces, using CT as the gold standard (well, some studies also used flow of air from thoracocentesis). Ultrasound was better. Standing x-ray might compare to, or even exceed ultrasound, but in most of our patients where we need to rule out pneumothorax, a standing CXR is not an option. And supine, or any form of chest x-ray in trauma might not be all that valuable anyway, see this post.
The systematic review in Chest found that both US and CXR were specific when finding a suspected pneumothorax, but ultrasound was over 90% sensitive, whereas supine CXR only 50% sensitive! So, do you still want to use supine CXR? Study abstract below:
I found this study via Annals of Emergency Medicine, which has a series of Review Snapshots aimed at emergency docs and others with attention deficit disorders. They recently did a Review Snapshot on the ultrasound vs supine CXR for pneumothorax. It gives a nice and concise overview of the actual meta-analysis. But almost feels too short to be academic! If you want to swim in the sea of detail and get the proper academic feel, get the full monty from Chest here:
So, how do I do this ultrasound stuff?
Check out this Ultrasound Podcast for a quick teaser on ultrasound for pneumothorax and pneumonia. That might get you pumped for looking at these two podcasts on Lung Ultrasound with Vicky Noble – part 1 and part 2. Brought to you by the great Ultrasound Podcast team, Matt & Mike.
And thanks to @lwestafer for pointing me to the Review Snapshot.