Role of chest ultrasonography in the diagnosis of lung contusion

AbstractObjectiveIn this study we assessed the diagnostic performance of chest ultrasonography in lung contusion (LC). The study investigated the possible clinical applicability of chest ultrasonography for the diagnosis of LC in comparison to chest X-ray (CXR) and chest computed tomography (CT) (as a gold standard). Design: a screening cross-sectional study. Setting: Critical Care Department, Emergency Department, Alexandria main university hospital.Patients50 patients of both genders admitted to the Emergency Department and the Critical Care Department presented with isolated blunt chest trauma or polytrauma with chest involvement.Methods50 patients admitted for blunt chest trauma were investigated using ultrasonography to detect LC. After the ultrasound study, all patients were submitted to chest X-ray and CT. The sonographic patterns indicative of LC included the following: (1) the alveolointerstitial syndrome (AIS) [defined by increase in B-line artifacts]; and (2) peripheral parenchymal lesion (PPL) [defined by the presence of C-lines: hypoechoic subpleural focal images with or without pleural line gap].ResultsThe diagnosis of LC was established by CT scan in 40 patients. If AIS is considered, sensitivity of lung ultrasonography in detection of AIS was 97.50%, specificity was 90.0%, PPV 97.50%, NPV 90.0% and accuracy was 96.0%. If PPL is alternatively considered, sensitivity of lung ultrasonography in detection of PPL was 92.50%, specificity was 100.0%, PPV was 100.0%, NPV was 76.92% and accuracy was 94.0%. As a whole sensitivity of lung ultrasonography in detection of lung contusion was 97.50%, specificity was 90.0%, PPV was 97.50%, NPV was 90.0% and accuracy was 96.0%. Chest X-ray had sensitivity of 40.0%, specificity was 90.0%, with PPV 94.12%, NPV 27.27% and accuracy of 50.0%.ConclusionLung ultrasound is a bedside, reliable, dynamic, rapid, and non-invasive technique and may be of significant value in the diagnosis of lung contusion in blunt chest trauma patients