title: Bedside sonography for detection of postprocedure pneumothorax.
abstract: OBJECTIVE
  Bedside sonography for diagnosis of pneumothorax has been well described in emergency and trauma medicine literature. Its role in detection of iatrogenic pneumothorax has not been well studied. We describe the performance of bedside sonography for detection of procedure-related pneumothorax and highlight some limitations.
  
  
  METHODS
  A total of 185 patients underwent thoracentesis (n = 60), transbronchial biopsy (n = 48), and computed tomography-guided needle lung biopsy (n = 77). Bedside preprocedure and postprocedure transthoracic sonography and postprocedure chest radiograph were performed in all patients. Patients in whom the pleural surface was not well imaged with sonography were said to have a limited examination. Chest radiography was the standard for diagnosing pneumothorax.
  
  
  RESULTS
  Chest radiography showed pneumothorax in 8 of 185 patients (4.0%). These patients had undergone computed tomography-guided needle lung biopsy (n = 7) and transbronchial needle lung biopsy (n = 1). Sonography showed pneumothorax in 7 of these patients. The sensitivity, specificity, and diagnostic accuracy were 88%, 97%, and 97%, respectively. Limited-quality sonographic examinations due to preexisting lung disease were seen in 43 of 185 patients. The positive and negative likelihood ratios for patients with adequate scans were 55 and 0.17, respectively. The likelihood ratio for patients with limited-quality scans was 1.08.
  
  
  CONCLUSIONS
  When a good-quality scan is achieved, bedside chest sonography is a valuable tool for evaluation of postprocedure pneumothorax. Patients with preexisting lung disease, in whom the quality of the sonographic examination is limited, should be studied with chest radiography.
authors.affiliation: New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10021, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Shostak
authors.forename: Douglas
authors.initials: D
authors.lastname: Brylka
authors.forename: Joseph
authors.initials: J
authors.lastname: Krepp
authors.forename: Bradley
authors.initials: B
authors.lastname: Pua
authors.forename: Abraham
authors.initials: A
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000706:statistics & numerical data*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D064887:Observational Studies as Topic; D019152:Paracentesis / Q000706:statistics & numerical data*; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: biopsy; pneumothorax; sonography