Prospective evaluation of thoracic ultrasound in the detection of pneumothorax

Background: Thoracic ultrasound may rapidly diagnose pneumothorax when radi ographs are unobtainable; the accuracy is not known. Methods: We prospectively evaluated thoracic ultrasound detection of pneumo thorax in patients at high suspicion of pneumothorax. The presence of "lung sliding" or "comet tail" artifacts were determined in patients by ultrasou nd before radiologic verification of pneumo-thorax by residents instructed in thoracic ultrasound. Results were compared with standard radiography, Results: There were 382 pa tients enrolled; the cause of injury was blunt (281 of 382), gunshot wound (22 of 382), stab wound (61 of 382), and spontaneous (18 of 382), Pneumotho rax was demonstrated on chest radiograph in 39 patients and confirmed by ul trasound in 37 of 39 patients (95% sensitivity); two pneumothoraces could n ot be diagnosed because of subcutaneous air; the true-negative rate was 100 %. Conclusion: Thoracic ultrasound reliably diagnoses pneumothorax. Expansion of the focused abdominal sonography for trauma (FAST) examination to includ e the thorax should he investigated for terrestrial and space medical appli cations.