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Accuracy of Transthoracic Sonography in Detection of Pneumothorax After Sonographically Guided Lung Biopsy: Prospective Comparison with Chest Radiography

¹ Section of Interventional Ultrasound, Department of Internal Medicine, St. Anna Hospital, corso Giovecca 203, 44100 Ferrara, Italy.
² Department of Internal Medicine, St. Anna Hospital, 44100 Ferrara, Italy.
³ Division of Oncology, City Hospital, 47900 Rimini, Italy.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —53-year-old man with lung nodule extending to pleura. Longitudinal sonogram (5-MHz convex probe) of second left anterior intercostal space obtained after thoracic sonographically guided biopsy shows smooth and hyperechoic pleural line, representing pleura-aerated lung interface, and hypoechoic nodule with irregular margins (outline). Under real-time conditions, breath-dependent motion of pleural line (lung sliding) would be seen. One comet-tail artifact (arrows) is present near nodule, reflecting normally aerated lung. Postbiopsy pneumothorax can be excluded.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —66-year-old woman with pulmonary fibrosis. Longitudinal sonogram (5-MHz convex probe) shows irregular, fragmented, thickened pleural line with numerous comet-tail artifacts.

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —69-year-old man with pneumothorax after transthoracic sonographically guided biopsy of pulmonary nodule. Longitudinal B-mode image (5-MHz convex probe) of right anterior third intercostal space shows horizontal reverberation artifacts. Loss of breath-dependent motion of pleural line is evident.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —69-year-old man with pneumothorax after transthoracic sonographically guided biopsy of pulmonary nodule. M-mode image corresponding to A shows loss of breath-dependent motion of pleural line as artifactual immobility (frozen echoes).

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —69-year-old man with pneumothorax after transthoracic sonographically guided biopsy of pulmonary nodule. Longitudinal B-mode image obtained after resolution of pneumothorax shows pleural line.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —69-year-old man with pneumothorax after transthoracic sonographically guided biopsy of pulmonary nodule. M-mode image obtained after resolution of pneumothorax shows breath-dependent movements as single, thin comet-tail artifact (arrow) quite different from frozen echoes of A and B.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —72-year-old woman with pulmonary fibrosis and postbiopsy pneumothorax (PNX). Sonogram (7.5-MHz linear probe) shows lung point. Horizontal reverberation artifacts (vertical arrows) are interrupted by reappearance of irregular, fragmented, thickened pleural line with comet-tail artifacts (oblique arrows).

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