Chest
Volume 130, Issue 2, August 2006, Pages 533-538
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Original Research: CHEST TRAUMA
Chest Ultrasonography in Lung Contusion

https://doi.org/10.1378/chest.130.2.533Get rights and content

Study objective

Despite the high prevalence of chest trauma and its high morbidity, lung contusion (LC) often remains undiagnosed in the emergency department (ED). The present study investigates the possible clinical applicability of chest ultrasonography for the diagnosis of LC in the ED in comparison to radiography and CT.

Materials and methods

One hundred twenty-one patients admitted to the ED for blunt chest trauma were investigated using ultrasonography by stage III longitudinal scanning of the anterolateral chest wall to detect LC. Data were retrospectively collected in an initial series of 109 patients (group 1) and prospectively in the next 12 patients (group 2). All patients who presented with pneumothorax were excluded. After the ultrasound study, all patients were submitted to chest radiography (CXR) and CT. The sonographic patterns indicative of LC included the following: (1) the alveolointerstitial syndrome (AIS) [defined by increase in B-line artifacts]; and (2) peripheral parenchymal lesion (PPL) [defined by the presence of C-lines: hypoechoic subpleural focal images with or without pleural line gap].

Results

The diagnosis of LC was established by CT scan in 37 patients. If AIS is considered, the sensitivity of ultrasound study was 94.6%, specificity was 96.1%, positive and negative predictive values were 94.6% and 96.1%, respectively, and accuracy was 95.4%. If PPL is alternatively considered, sensitivity and negative predictive values drop to 18.9% and 63.0%, respectively, but both specificity and positive predictive values increased to 100%, with an accuracy of 65.9%. Radiography had sensitivity of 27% and specificity of 100%.

Conclusions

Chest ultrasonography can accurately detect LC in blunt trauma victims, in comparison to CT scan.

Section snippets

MATERIALS AND METHODS

This study took place in the EDs of three hospitals in Italy: Lucca and Valle del Serchio general hospitals in Lucca, and Policlinico A. Gemelli in Rome. Consecutive patients who presented with isolated blunt chest trauma or polytrauma with chest involvement and an injury severity score (ISS) > 15 were enrolled between April 2001 and December 2003. The population comprised 121 patients (Fig 1) who were classified into two groups. Group 1 consisted of 109 patients who were simultaneously

RESULTS

After the exclusion of 33 patients who presented with pneumothorax (prevalence, 27.3%), a total of 88 patients were enrolled: 76 patients in group 1 (retrospective; 47 men and 29 women; mean age, 32 years [range, 18 to 89 years]) and 12 patients in group 2 (prospective; 8 men and 4 women; mean age, 41 years [range, 24 to 77 years]). All patients who presented with important subcutaneous emphysema had pneumothorax and were excluded. All cases of pneumothorax were found in group 1.

In the enrolled

DISCUSSION

The radiographic diagnosis of LC is based on classic signs: irregular, roughly nodular opacities either isolated or merging, homogenous consolidations, and various combinations of these modalities.18 These signs may take several hours to appear, most are present in 24 h, and all vanish in a few days.19 It is agreed that for these reasons, given the low sensitivity of CXR for the diagnosis of LC in the ED,2021 several LCs remain undiagnosed. Spiral CT is able to show many CXR occult lesions and

CONCLUSION

This study reinforces the applicability of the sonographic study of the lung in the emergency setting. In addition to the well-established role of ultrasound in the diagnosis of pneumothorax, hemothorax, and hemoperitoneum, the diagnosis of LC may also be accessed. The given data may support a more selective use of CT. Further studies are being performed to investigate the correlation of a B-line score and the LC volume as measured by CT. This could restrict even further the need of CT scans on

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    A research grant was provided by the Ministero della Pubblica Istruzione e della Ricerca Scientifica.

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