title: Role of ultrasonography in the diagnosis and management of pneumothorax following transbronchial lung biopsy.
abstract: BACKGROUND
  Pneumothorax (PTX) following flexible bronchoscopy (FB) and transbronchial lung biopsy (TBLB) occurs in 1% to 6% of cases. Chest radiography (CXR) is therefore routinely requested to detect PTX following TBLB. The objective of this study was to prospectively evaluate the accuracy of ultrasound (US) in the detection of post-TBLB PTX.
  
  
  METHODS
  Consecutive patients undergoing elective FB at a tertiary care hospital were included in the study. A real-time US was used to rule out PTX immediately after FB. PTX was defined by the absence of lung sliding and the presence of "lung point" and "stratosphere" sign. In cases of PTX, US was repeated at 2-hour intervals, and the resolution or progression of PTX was assessed based on dynamic shifts of the "lung points."
  
  
  RESULTS
  A total of 379 FB procedures and 113 TBLB were performed during the study period. PTX occurred in 8 (2.1%) patients. US detected all cases of PTX, whereas CXR missed 1 PTX. The sensitivity, specificity, and overall accuracy for US were 100% as compared with sensitivity of 87.5% and accuracy of 99.6% for the CXR group. Shift of the "lung point" below the mid-thoracic line implied the progression of PTX and hence favored intervention (performed in 3 cases), whereas conservative management was done in cases where "lung point" shifted above mid-thoracic line.
  
  
  CONCLUSIONS
  This study demonstrates a good sensitivity of US in detecting PTX following TBBL. Bedside US may become the method of choice for diagnosing, monitoring, and managing PTX after TBLB.
authors.affiliation: *Department of Pulmonary Medicine, Institute of Liver & Biliary Sciences, New Delhi †Department of Pulmonary Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Kumar
authors.forename: Ritesh
authors.initials: R
authors.lastname: Agarwal
authors.forename: Ashutosh N
authors.initials: AN
authors.lastname: Aggarwal
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Gupta
authors.forename: Surinder K
authors.initials: SK
authors.lastname: Jindal
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects*; D001999:Bronchoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers; D014463:Ultrasonography; D055815:Young Adult