Chest

Chest Ultrasonography in Lung Contusion*
Gino Soldati, Americo Testa, Fernando R. Silva, Luigi Carbone, Grazia Portale and Nicolò G. Silveri Chest 2006;130;533-538 DOI 10.1378/chest.130.2.533

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CHEST is theofficial journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright 2007 by the American College of Chest Physicians, 3300 Dundee Road, Northbrook IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://www.chestjournal.org/site/misc/reprints.xhtml)ISSN:0012-3692

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CHEST

Original Research
CHEST TRAUMA

Chest Ultrasonography in Lung Contusion*
Gino Soldati, MD; Americo Testa, MD; Fernando R. Silva, MD; Luigi Carbone, MD, PhD; Grazia Portale, MD; and Nicolo G. Silveri, MD `

Study objective: Despite the highprevalence of chest trauma and its high morbidity, lung contusion (LC) often remains undiagnosed in the emergency department (ED). The present study investigates the possible clinical applicability of chest ultrasonography for the diagnosis of LC in the ED in comparison to radiography and CT. Materials and methods: One hundred twenty-one patients admitted to the ED for blunt chest trauma wereinvestigated using ultrasonography by stage III longitudinal scanning of the anterolateral chest wall to detect LC. Data were retrospectively collected in an initial series of 109 patients (group 1) and prospectively in the next 12 patients (group 2). All patients who presented with pneumothorax were excluded. After the ultrasound study, all patients were submitted to chest radiography (CXR) and CT. Thesonographic 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]. Results: The diagnosis of LC was established by CT scan in 37 patients. If AIS is considered, thesensitivity of ultrasound study was 94.6%, specificity was 96.1%, positive and negative predictive values were 94.6% and 96.1%, respectively, and accuracy was 95.4%. If PPL is alternatively considered, sensitivity and negative predictive values drop to 18.9% and 63.0%, respectively, but both specificity and positive predictive values increased to 100%, with an accuracy of 65.9%. Radiography hadsensitivity of 27% and specificity of 100%. Conclusions: Chest ultrasonography can accurately detect LC in blunt trauma victims, in comparison to CT scan. (CHEST 2006; 130:533–538)
Key words: chest trauma; chest ultrasound; lung contusion; lung sonography; pulmonary contusion; thoracic ultrasonography Abbreviations: AIS alveolointerstitial syndrome; CXR chest radiography; ED ISS injury severity score; LClung contusion; PPL peripheral parenchymal lesion emergency department;

frequent clinical L ung contusion (LC) is afound a 26% rate ofentity. lung Previous studies have
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involvement in blunt chest trauma, with varying severity scores. The need for surgical intervention in chest trauma is not high (10 to 15%),2 but the diagnosis of LC determines the need of a close physiologic follow-up.This injury is an independent
*From the Operative Unit of Emergency Medicine (Dr. Soldati), Ospedale di Castelnuovo di Garfagnana, Lucca, Italy; the Department of Emergency Medicine (Drs. Testa, Carbone, Portale, and Silveri) Catholic University, School of Medicine, Policlinico A. Gemelli, Rome, Italy; and Hospital de Pronto Socorro Municipal de Porto Alegre (Dr. Silva), Porto Alegre, Brazil. A...