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Auinger D, Orlob S, Wittig J, Honnef G, Heschl S, Feigl G, Prause G. Pneumothorax in a Thiel cadaver model of cardiopulmonary resuscitation. World J Emerg Med 2023; 14:143-147. [PMID: 36911063 PMCID: PMC9999140 DOI: 10.5847/wjem.j.1920-8642.2023.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/24/2022] [Indexed: 02/09/2023] Open
Affiliation(s)
- Daniel Auinger
- Division of Anaesthesiology and Intensive Care Medicine 1, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz 8036, Austria
| | - Simon Orlob
- Division of Anaesthesiology and Intensive Care Medicine 2, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz 8036, Austria
| | - Johannes Wittig
- Medical University of Graz, Graz 8036, Austria.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus 8200, Denmark.,Department of Medicine, Randers Regional Hospital, Randers 8930, Denmark
| | - Gabriel Honnef
- Division of Anaesthesiology and Intensive Care Medicine 1, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz 8036, Austria
| | - Stefan Heschl
- Division of Anaesthesiology and Intensive Care Medicine 2, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz 8036, Austria
| | - Georg Feigl
- Chair of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz 8036, Austria.,Institute of Morphology and Clinical Anatomy, Faculty of Health/School of Medicine, Witten/Herdecke University, Witten 58448, Germany
| | - Gerhard Prause
- Division of Anaesthesiology and Intensive Care Medicine 1, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz 8036, Austria
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2
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Piccolo CL, Liuzzi G, Petrone A, Fusco N, Blandino A, Monopoli F, Antinori A, Girardi E, Vallone G, Brunese L, Ianniello S. The role of Lung Ultrasound in the diagnosis of SARS-COV-2 disease in pregnant women. J Ultrasound 2022:10.1007/s40477-022-00745-5. [PMID: 36574192 PMCID: PMC9793376 DOI: 10.1007/s40477-022-00745-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/10/2022] [Indexed: 12/28/2022] Open
Abstract
AIM To evaluate the role of lung ultrasound (LUS) in recognizing lung abnormalities in pregnant women affected by COVID-19 pneumonia. MATERIALS AND METHODS An observational study analyzing LUS patterns in 60 consecutively enrolled pregnant women affected by COVID-19 infection was performed. LUS was performed by using a standardized protocol by Soldati et al. The scoring system of LUS findings ranged from 0 to 3 in increasing alteration severity. The highest score obtained from each landmark was reported and the sum of the 12 zones examined was calculated. RESULTS Patients were divided into two groups: 26 (43.3%) patients with respiratory symptoms and 32 (53.3%) patients without respiratory symptoms; 2 patients were asymptomatic (3.3%). Among the patients with respiratory symptoms 3 (12.5%) had dyspnea that required a mild Oxygen therapy. A significant correlation was found between respiratory symptoms and LUS score (p < 0.001) and between gestational weeks and respiratory symptoms (p = 0.023). Regression analysis showed that age and respiratory symptoms were risk factors for highest LUS score (p < 0.005). DISCUSSION LUS can affect the clinical decision course and can help in stratifying patients according to its findings. The lack of ionizing radiation and its repeatability makes it a reliable diagnostic tool in the management of pregnant women.
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Affiliation(s)
- Claudia Lucia Piccolo
- Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppina Liuzzi
- National Institute for Infectious Diseases ‘L. Spallanzani’, IRCCS, Rome, Italy
| | - Ada Petrone
- Diagnostic Imaging for Infectious Diseases, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00161 Rome, Italy
| | - Nicoletta Fusco
- Diagnostic Imaging for Infectious Diseases, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00161 Rome, Italy
| | | | | | - Andrea Antinori
- HIV/AIDS Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00161 Rome, Italy
| | - Enrico Girardi
- National Institute for Infectious Diseases ‘L. Spallanzani’, IRCCS, Rome, Italy
| | - Gianfranco Vallone
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Stefania Ianniello
- Diagnostic Imaging for Infectious Diseases, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00161 Rome, Italy
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3
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Leone E, Garipoli A, Ripani U, Lanzetti RM, Spoliti M, Creta D, Giannace C, Galluzzo A, Trinci M, Galluzzo M. Imaging Review of Pelvic Ring Fractures and Its Complications in High-Energy Trauma. Diagnostics (Basel) 2022; 12:diagnostics12020384. [PMID: 35204475 PMCID: PMC8870907 DOI: 10.3390/diagnostics12020384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 02/06/2023] Open
Abstract
Pelvic ring fractures are common in high-energy blunt trauma, especially in traffic accidents. These types of injuries have a high rate of morbidity and mortality, due to the common instability of the fractures, and the associated intrapelvic vascular and visceral complications. Computed tomography (CT) is the gold standard technique in the evaluation of pelvic trauma because it can quickly and accurately identify pelvic ring fractures, intrapelvic active bleeding, and lesions of other body systems. To properly guide the multidisciplinary management of the polytrauma patient, a classification criterion is mandatory. In this review, we decided to focus on the Young and Burgess classification, because it combines the mechanism and the stability of the fractures, helping to accurately identify injuries and related complications.
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Affiliation(s)
- Edoardo Leone
- Department of Emergency Radiology, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; (M.T.); (M.G.)
- Correspondence:
| | - Andrea Garipoli
- Department of Radiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Umberto Ripani
- Department of Emergency and Major Trauma, Division of Anaesthesia, Analgesia and Intensive Care and Pain Therapy, Ospedali Riuniti di Ancona, 60162 Ancona, Italy;
| | - Riccardo Maria Lanzetti
- Orthopaedics and Traumatology Unit, Department of Emergency and Acceptance, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; (R.M.L.); (M.S.)
| | - Marco Spoliti
- Orthopaedics and Traumatology Unit, Department of Emergency and Acceptance, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; (R.M.L.); (M.S.)
| | - Domenico Creta
- Physical Medicine and Rehabilitation Service, Casa di Cura Privata Madre Fortunata Toniolo, 40141 Bologna, Italy;
| | | | - Antonio Galluzzo
- Department of Radiology, Università Degli Studi di Firenze, 50121 Florence, Italy;
| | - Margherita Trinci
- Department of Emergency Radiology, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; (M.T.); (M.G.)
| | - Michele Galluzzo
- Department of Emergency Radiology, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; (M.T.); (M.G.)
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Schiebler ML, Hartung M. Postprocedural Pneumothorax Detection by Deep Learning on Chest Radiographs. Radiology 2022; 303:442-443. [PMID: 35076307 DOI: 10.1148/radiol.212973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mark L Schiebler
- From the Department of Radiology, UW-Madison School of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center, Madison, WI 53794
| | - Michael Hartung
- From the Department of Radiology, UW-Madison School of Medicine and Public Health, 600 Highland Ave, E3/378 Clinical Science Center, Madison, WI 53794
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Santorelli JE, Chau H, Godat L, Casola G, Doucet JJ, Costantini TW. Not so FAST-Chest ultrasound underdiagnoses traumatic pneumothorax. J Trauma Acute Care Surg 2022; 92:44-48. [PMID: 34932040 DOI: 10.1097/ta.0000000000003429] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Ultrasonography for trauma is a widely used tool in the initial evaluation of trauma patients with complete ultrasonography of trauma (CUST) demonstrating equivalence to computed tomography (CT) for detecting clinically significant abdominal hemorrhage. Initial reports demonstrated high sensitivity of CUST for the bedside diagnosis of pneumothorax. We hypothesized that the sensitivity of CUST would be greater than initial supine chest radiograph (CXR) for detecting pneumothorax. METHODS A retrospective analysis of patients diagnosed with pneumothorax from 2018 through 2020 at a Level I trauma center was performed. Patients included had routine supine CXR and CUST performed prior to intervention as well as confirmatory CT imaging. All CUST were performed during the initial evaluation in the trauma bay by a registered sonographer. All imaging was evaluated by an attending radiologist. Subgroup analysis was performed after excluding occult pneumothorax. Immediate tube thoracostomy was defined as tube placement with confirmatory CXR within 8 hours of admission. RESULTS There were 568 patients screened with a diagnosis of pneumothorax, identifying 362 patients with a confirmed pneumothorax in addition to CXR, CUST, and confirmatory CT imaging. The population was 83% male, had a mean age of 45 years, with 85% presenting due to blunt trauma. Sensitivity of CXR for detecting pneumothorax was 43%, while the sensitivity of CUST was 35%. After removal of occult pneumothorax (n = 171), CXR was 78% sensitive, while CUST was 65% sensitive (p < 0.01). In this subgroup, CUST had a false-negative rate of 36% (n = 62). Of those patients with a false-negative CUST, 50% (n = 31) underwent tube thoracostomy, with 85% requiring immediate placement. CONCLUSION Complete ultrasonography of trauma performed on initial trauma evaluation had lower sensitivity than CXR for identification of pneumothorax including clinically significant pneumothorax requiring tube thoracostomy. Using CUST as the primary imaging modality in the initial evaluation of chest trauma should be considered with caution. LEVEL OF EVIDENCE Diagnostic Test study, Level IV.
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Affiliation(s)
- Jarrett E Santorelli
- From the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, UC San Diego School of Medicine, San Diego, California
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6
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Sommer A, Mark N, Kohlberg GD, Gerasi R, Avraham LW, Fan-Marko R, Eisenkraft A, Nachman D. Hemopneumothorax detection through the process of artificial evolution - a feasibility study. Mil Med Res 2021; 8:27. [PMID: 33894775 PMCID: PMC8070275 DOI: 10.1186/s40779-021-00319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tension pneumothorax is one of the leading causes of preventable death on the battlefield. Current prehospital diagnosis relies on a subjective clinical impression complemented by a manual thoracic and respiratory examination. These techniques are not fully applicable in field conditions and on the battlefield, where situational and environmental factors may impair clinical capabilities. We aimed to assemble a device able to sample, analyze, and classify the unique acoustic signatures of pneumothorax and hemothorax. METHODS Acoustic data was obtained with simultaneous use of two sensitive digital stethoscopes from the chest wall of an ex-vivo porcine model. Twelve second samples of acoustic data were obtained from the in-house assembled digital stethoscope system during mechanical ventilation. The thoracic cavity was injected with increasing volumes of 200, 400, 600, 800, and 1000 ml of air or saline to simulate pneumothorax and hemothorax, respectively. The data was analyzed using a multi-objective genetic algorithm that was used to develop an optimal mathematical detector through the process of artificial evolution, a cutting-edge approach in the artificial intelligence discipline. RESULTS The in-house assembled dual digital stethoscope system and developed genetic algorithm achieved an accuracy, sensitivity and specificity ranging from 64 to 100%, 63 to 100%, and 63 to 100%, respectively, in classifying acoustic signal as associated with pneumothorax or hemothorax at fluid injection levels of 400 ml or more, and regardless of background noise. CONCLUSIONS We present a novel, objective device for rapid diagnosis of potentially lethal thoracic injuries. With further optimization, such a device could provide real-time detection and monitoring of pneumothorax and hemothorax in battlefield conditions.
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Affiliation(s)
- Adir Sommer
- The Medical Corps, Israel Defense Forces (IDF), Tel Hashomer, 5262000, Ramat Gan, Israel.
| | - Noy Mark
- The Medical Corps, Israel Defense Forces (IDF), Tel Hashomer, 5262000, Ramat Gan, Israel
| | - Gavriel D Kohlberg
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, WA, 98195, USA
| | - Rafi Gerasi
- The Medical Corps, Israel Defense Forces (IDF), Tel Hashomer, 5262000, Ramat Gan, Israel
| | - Linn Wagnert Avraham
- The Institute for Research in Military Medicine, the Faculty of Medicine, the Hebrew University of Jerusalem and the IDF Medical Corps, 9112102, Jerusalem, Israel
| | - Ruth Fan-Marko
- The Hebrew University School of Medicine, 9112102, Jerusalem, Israel
| | - Arik Eisenkraft
- The Institute for Research in Military Medicine, the Faculty of Medicine, the Hebrew University of Jerusalem and the IDF Medical Corps, 9112102, Jerusalem, Israel
| | - Dean Nachman
- The Institute for Research in Military Medicine, the Faculty of Medicine, the Hebrew University of Jerusalem and the IDF Medical Corps, 9112102, Jerusalem, Israel.,The Hebrew University School of Medicine, 9112102, Jerusalem, Israel.,Department of Medicine, Hadassah Medical Center, 9112102, Jerusalem, Israel
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7
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Necessity of routine chest radiograph in blunt trauma resuscitation: Time to evaluate dogma with evidence. J Trauma Acute Care Surg 2021; 89:e69-e70. [PMID: 32467468 DOI: 10.1097/ta.0000000000002793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Diagnosis of pneumothorax in major trauma: fast or accuracy?-Author's Reply. J Ultrasound 2020; 24:227-228. [PMID: 32880828 DOI: 10.1007/s40477-020-00525-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022] Open
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Value of point-of-care ultrasonography compared with computed tomography scan in detecting potential life-threatening conditions in blunt chest trauma patients. Ultrasound J 2020; 12:36. [PMID: 32747992 PMCID: PMC7399008 DOI: 10.1186/s13089-020-00183-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ultrasonography is a suitable modality that can potentially improve patient care, saving time and lives. Purpose This article has evaluated the caveats and pitfalls of point-of-care ultrasonography in the diagnosis of pneumothorax, hemothorax and contusion. Materials and methods This prospective study was performed in 157 patients with blunt chest trauma in 3 university hospitals. Ultrasonography was performed by 2 board-certified emergency medicine specialists and an emergency medicine resident PGY-3 after passing the training process successfully. Results The false-negative cases were not significantly correlated with accompanying traumatic injuries. Lung ultrasonography accompanied by chest physical examination show accuracy 91.8. Point-of-care ultrasonography (PoCUS) showed sensitivity 75.0%, specificity 100%, positive-predictive value (PPV) of 100% and a negative-predictive value (NPV) of 94.9% for the diagnosis of pneumothorax. For hemothorax, bedside PoCUS had a sensitivity of 45.4%, specificity of 100%, PPV of 100% and NPV of 91.8%. PoCUS was assessed 58.1% sensitive and 100% specific for detecting lung contusion with positive-predictive value (PPV) of 100% and a negative-predictive value (NPV) of 86.3%. Performing US resulted in no false-positive cases. Conclusions Point-of-care ultrasonography was highly sensitive to detect pneumothorax and can be beneficial for the disposition of stable patients and to detect PTX in unstable patients before transferring to the operating room. It is also moderately appropriate for the diagnosis of hemothorax and lung contusion compared to the gold standard, CT scan. It is essential to consider the false-negative and false-positive instances of lung ultrasound in various situations to enhance management and disposition of blunt thoracic injuries.
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10
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Ianniello S, Conte P, Di Serafino M, Miele V, Trinci M, Vallone G, Galluzzo M. Diagnostic accuracy of pubic symphysis ultrasound in the detection of unstable pelvis in polytrauma patients during e-FAST: the value of FAST-PLUS protocol. A preliminary experience. J Ultrasound 2020; 24:423-428. [PMID: 32519303 DOI: 10.1007/s40477-020-00483-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Extended focused abdominal sonography for trauma (e-FAST) is part of the primary survey in patients with high-energy trauma. However, it does not identify patients with retroperitoneal haemorrhage associated with significant pelvic trauma. A traumatic diastasis of pubic symphysis, as well as an 'open book' (OB) pelvic injury, is a diagnostic clue to recognize unstable pelvis with higher risk of bleeding. FAST-PLUS (FAST-PL pleural -US ultrasound of symphysis) protocol is an addendum to the e-FAST, which takes into account the study of the pubic symphysis in a single transverse scan after the traditional focused evaluation of the abdomen and thorax. OBJECTIVES The aim of this study is to determine the value of FAST-PLUS protocol in the evaluation of pubic symphysis injuries and the identification of 'open book' (OB) unstable pelvic fractures. METHODS Between January 2018 and December 2019, we retrospectively reviewed 67 polytraumatised patients with clinical suspicion of pelvic instability and with known anteroposterior pelvis compression injuries who underwent e-FAST with an additional transverse scan of the pubic symphysis, named the FAST-PLUS protocol and computed tomography (CT) exam in order to assess the correlation between them in defining the presence or absence of pubic symphyseal widening (SW). A cutoff value of 2.5 cm in transverse diameter was used to diagnose OB unstable pelvic injury. The results were analysed using Cohen's test, which uses the Kappa value as the reference index. RESULTS The analysis carried out to assess the degree of agreement between FAST-PLUS and CT showed 5/67 patients (7.5%) with a critical pubic SW (> 2.5 cm transverse diameter) suggestive of unstable OB pelvic injury and 62/67 (92,5%) without any signs of SW at FAST-PLUS. At CT, findings of unstable OB pelvic fracture were confirmed in all patients with positive results at FAST-PLUS. Similarly, all patients with negative results for critical pubic SW (< 2.5 cm in transverse diameter) at FAST-PLUS were found to be negative at CT exam. The level of correlation between the two methods was high (Kappa value = 1) CONCLUSION: The FAST-PLUS protocol shows a high correlation with CT exam, which is the gold standard for the detection of unstable pubic SW, as well as OB pelvic injury, in polytraumatised patients. Inclusion of FAST-PLUS in patient management in the shock room may lead to a quicker identification of patients with unstable pelvis and to faster therapeutic work-up.
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Affiliation(s)
- Stefania Ianniello
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy.
| | - Paola Conte
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Margherita Trinci
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy
| | - Gianfranco Vallone
- Department of Life and Health, "Vincenzo Tiberio" University of Molise, Campobasso, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, S. Camillo Hospital, C.ne Gianicolense, 87, 00152, Rome, Italy
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Cipriani C, D'Agostino F, Rea G. Diagnosis of pneumothorax in major trauma: fast or accuracy? J Ultrasound 2020; 23:223-224. [PMID: 32144683 DOI: 10.1007/s40477-020-00444-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/22/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Cristiana Cipriani
- Department of Clinical, Internal Medicine, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
| | | | - Gaetano Rea
- Department of Radiology, "Vincenzo Monaldi" Hospital-AORN Ospedale Dei Colli, Naples, Italy
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Boccatonda A, Primomo G, Cocco G, D'Ardes D, Marinari S, Montanari M, Giostra F, Schiavone C. Not all abolished lung sliding are pneumothorax: the case of a particular lung atelectasis. J Ultrasound 2020; 24:519-523. [PMID: 31970716 DOI: 10.1007/s40477-020-00427-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/09/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Lung ultrasound (LUS) is expanding from the field of emergency medicine, also to the pneumological specialist field, becoming part of the diagnostic procedure of lung consolidation. CASE PRESENTATION A 78-year-old male was admitted to our emergency department for exertional dyspnea. LUS was performed, thus showing at right hemitorax air interface, A lines pattern, pleural sliding abolished on the whole hemitorax, thus suggesting a pneumothorax, but no evidence of lung point. A scan of lower lung segment showed an absence of the diaphragmatic excursion, suggestive for hemiparalysis of the diaphragm muscle, then confirmed by a subcostal scan. Moreover, at the lower segment of right hemitorax there was mild pleural effusion allowing the visualization of a round-shaped parenchymal consolidation with the absence of air bronchograms. CONCLUSIONS LUS allowed the visualization of a particular and rare disease such as anthracosis-associated rounded atelectasis, thus leading to a more correct and faster patient management.
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Affiliation(s)
- A Boccatonda
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy.
| | - G Primomo
- Pneumology Department, SS Annunziata Hospital, Chieti, Italy
| | - G Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - D D'Ardes
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - S Marinari
- Pneumology Department, SS Annunziata Hospital, Chieti, Italy
| | - M Montanari
- Emergency Department, Infermi Hospital, Rimini, Italy
| | - F Giostra
- Emergency Department, Murri Hospital, Fermo, Italy
| | - C Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
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