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Pneumothorax

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Basic Ultrasound Skills “Head to Toe” for General Intensivists

Part of the book series: Lessons from the ICU ((LEICU))

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Abstract

Lung ultrasound has high sensitivity (88%) and specificity (100%) for pneumothorax detection, with good correlation with CT scan. Lung ultrasound can be performed with any ultrasound machine and probe; however, a high-frequency probe allows the best visualization of the pleural line for pneumothorax detection. A complete examination includes 12 zones (2 anterior, 2 lateral, and 2 posterior per hemithorax); free air collection can be ruled out with a simplified approach focused on anterior fields, in particular in emergency situations. The presence of lung sliding/seashore sign, lung pulse, B-lines, or real images (consolidations/effusions) rules out pneumothorax with 100% negative predictive value. The absence of lung sliding with A-lines, confirmed by the stratosphere sign, strongly suggests pneumothorax, with high sensitivity and moderate context-related specificity. This can be mimicked by clinical situations limiting the lung sliding (pleural bullae and emphysema, hyperinflation). To confirm pneumothorax with 100% positive predictive value, it is essential to visualize the lung point, contact point between air collection and collapsed lung. Mapping the lung point on the thorax allows semi-quantification of the pneumothorax and guides thoracic drainage. In case of complete collapse, the lung point cannot be visualized. Lung ultrasound limitations include thoracic dressing, subcutaneous emphysema, and adequate training.

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Author information

Authors and Affiliations

  1. Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Silvia Mongodi

  2. Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università di Pavia, Pavia, Italy

    Giulia Salve & Francesco Mojoli

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  1. Silvia Mongodi
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  2. Giulia Salve
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  3. Francesco Mojoli
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Editors and Affiliations

  1. Anesthesia and Intensive Care, Ospedale Policlinico San Martino, Genova, Italy

    Chiara Robba

  2. Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy

    Antonio Messina

  3. Department of Critical Care, King’s College Hospital, London, UK

    Adrian Wong

  4. Intensive Care Medicine Unit, Hôpital Ambroise-Paré, Boulogne-Billancourt, France

    Antoine Vieillard-Baron

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Mongodi, S., Salve, G., Mojoli, F. (2023). Pneumothorax. In: Robba, C., Messina, A., Wong, A., Vieillard-Baron, A. (eds) Basic Ultrasound Skills “Head to Toe” for General Intensivists. Lessons from the ICU. Springer, Cham. https://doi.org/10.1007/978-3-031-32462-8_8

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  • DOI: https://doi.org/10.1007/978-3-031-32462-8_8

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