In diagnosis of pleural effusion and pneumothorax in the intensive care unit patients: Can chest us replace bedside plain radiography?

Aim: To compare the role of chest US and bedside plain chest radiography in the evaluation of intensive care patients having pleural effusion and pneumothorax. Chest computed tomography has been used as an ideal standard. Patients and methods: Sixty critically ill patients with chest troubles and positive CT, were be studied with chest US and bedside CXR .Two pathologic abnormalities were be evaluated: pneumothorax and pleural effusion. Each hemithorax had been examined for the existence or absence of each pathology. All patients had been assessed by clinical examination of chest, full clinical history, laboratory assessment. All patients who had pleural effusion underwent US guided FNAC. Results: One hundred twenty hemithoraces had been investigated by the three imaging techniques. The sensitivity, specificity and diagnostic accuracy of bedside CXR were 54.5, 96 and 83.3% for pneumothorax and 76.2, 70.6 and 75% for pleural effusion, respectively. The corresponding values for chest US were 85.7, 97.9 and 95.2% for pneumothorax and 100, 100, and 100% for pleural effusion, respectively. Conclusions: In evaluation of ICU patients with pleural effusion and pneumothorax, chest US is the first bedside tool with high diagnostic performance. These chest conditions are urgent especially in seriously ill patients, as both need US guided drainage. Chest US has many advantages, including non invasive examination in multiple planes, free of radiation hazard, less expensive, real-time, high sensitivity and diagnostic accuracy in chest lesions detection. Lung ultrasound is being exclusive than bedside chest X-ray and equal to chest CT in diagnosing pleural effusion and pneumothorax