by Dr. Diku Mandavia
It's ironic that one of the most efficient ways to detect pneumothorax in patients is also one of the most effective ways to prevent two of its more common clinical causes.
While scenarios that might trigger the suspicion of pneumothorax are too numerous to list, screening for it has included the standard trinity of chest-imaging procedures: x-rays, tomography, and ultrasound.
Ultrasound not only helps to diagnose pneumothorax, but it can play a significant role in helping to prevent it. A leading procedural cause for it in hospital settings is a failed central line placement or a poorly executed thoracentesis. However, a growing body of research and documented clinical experience supports that ultrasound-guided central line placements and thoracentesis greatly reduce the number of failed attempts and resulting complications.
In “Think Ultrasound When Evaluating for Pneumothorax,” author Vicki E. Noble, MD of Massachusetts General, proposes that ultrasound is the ideal pneumothorax screening modality, due to its portability and lack of “risk associated with repeated measures as clinical scenarios change.”
Dr. Noble’s article goes on to provide instruction for performing the examination, incorporates excellent research citations, and then concludes: “Using thoracic sonography as a screening tool may lead to decreased ordering of chest radiographs, thus saving time and money and improving the efficiency of treatment.”
It may come as no surprise that my colleagues and I at SonoSite enthusiastically support Dr. Noble’s conclusion. The entire article—a part of AIUM’s “think ultrasound first” Sound Judgment Series—is worth a thorough read.
By using ultrasound guidance for central venous line placement, Memorial Hermann Healthcare was able to attain zero iatrogenic pneumothoraces in multiple hospitals for a full year.
A study in the Journal of Clinical Ultrasound, Sonographically Guided Thoracentesis and Rate of Pneumothorax, documented a 52% decrease in the occurrence of an iatrogenic pneumothorax complication with the use of ultrasound guidance. (Barnes TW, Morgenthaler TI, et al.)
Numerous studies have been published indicating the medical advantages of using ultrasound guidance for increased accuracy in performing thoracentesis. United BioSource Corporation demonstrated that ultrasound guidance during thoracentesis also provides significant economic advantages by reducing occurrences of pneumothorax.
The more the medical establishment hears of the healthcare and economic benefits associated with the broader uses of ultrasound, the sooner more clinicians will—as the AIUM encourages—“think ultrasound first” when faced with many clinical scenarios.