Introduction: Chest ultrasonography is routinely used in evaluation of chest trauma for diagnosis of pulmonary injury. This study aimed to evaluate the accuracy of B-Lines for diagnosing lung contusion in patients with blunt trauma of the chest.
Methods: Trauma patients who met the inclusion criteria were enrolled in the study and underwent ultrasonography by trained emergency medicine residents. Ultrasound results were recorded in terms of number of B-lines and the existence of peripheral parenchymal lesion (PPL). After ultrasound, the patient underwent chest x-ray and chest CT scan (as reference test) and screening performance of B-lines and PPL were evaluated.
Results: 147 patients underwent chest ultrasound. The mean age of the patients was 40.74 ± 18.6 (78.9% male). B-lines˃3 had 94.0% (95% CI: 83.45-98.75) sensitivity and 57.7% (95% CI: 47.3-67.7) specificity, B-lines˃6 had 90.0% (95% CI: 78.2-96.7) sensitivity and 93.81% (95% CI: 87.0-97.7) specificity, and PPL had 34.0% (95% CI: 21.2-48.8) sensitivity and 100% (95% CI: 96.3-100.0) specificity. Composite findings of B-lines˃6 + PPL had 92.0% (95% CI: 80.8-97. 8) sensitivity and 93.8% (95% CI: 87.0-97.7) specificity in the diagnosis of lung contusion.
Conclusion: PPL and B-Lines˃6 had the highest accuracy in detecting lung contusion. B-Line˃6 had high sensitivity and specificity and was easy to perform; thus, it seems that B-Line˃6 could be considered as an alternative screening tool in detection of lung contusion.
Simon B, Ebert J, Bokhari F, Capella J, Emhoff T, Hayward T, 3rd, et al. Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline. The journal of trauma and acute care surgery. 2012;73(5 Suppl 4):S351-61.
Hoff SJ, Shotts SD, Eddy VA, Morris JA, Jr. Outcome of isolated pulmonary contusion in blunt trauma patients. The American surgeon. 1994;60(2):138-42.
Cobanoglu U, Melek M, Edirne Y. Chest radiography diagnosis of pulmonary contusion is associated with increased morbidity and mortality2010 March 01. 24-9 p.
Wanek S, Mayberry JC. Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Critical care clinics. 2004;20(1):71-81.
Allen GS, Coates NE. Pulmonary contusion: a collective review. The American surgeon. 1996;62(11):895-900.
Omert L, Yeaney WW, Protetch J. Efficacy of thoracic computerized tomography in blunt chest trauma. The American surgeon. 2001;67(7):660-4.
Reissig A, Kroegel C. Transthoracic sonography of diffuse parenchymal lung disease: the role of comet tail artifacts. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2003;22(2):173-80.
Rocco M, Carbone I, Morelli A, Bertoletti L, Rossi S, Vitale M, et al. Diagnostic accuracy of bedside ultrasonography in the ICU: feasibility of detecting pulmonary effusion and lung contusion in patients on respiratory support after severe blunt thoracic trauma. Acta anaesthesiologica Scandinavica. 2008;52(6):776-84.
Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134(1):117-25.
Soldati G, Testa A, Silva FR, Carbone L, Portale G, Silveri NG. Chest ultrasonography in lung contusion. Chest. 2006;130(2):533-8.
Helmy S, Beshay B, Hady MA, Mansour A. Role of chest ultrasonography in the diagnosis of lung contusion. Egypt J Chest Dis Tu. 2015;64(2):469-75.
Hosseini M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, Haji Ghanbari MJ, et al. Diagnostic Accuracy of Ultrasonography and Radiography in Detection of Pulmonary Contusion; a Systematic Review and Meta-Analysis. Emergency. 2015;3(4):127-36.
D L. General ultrasound in the critically ill. 2nd ed ed. Germany: Springer-Verlag; 2005.
Lichtenstein D, Meziere G, Biderman P, Gepner A, Barre O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. American journal of respiratory and critical care medicine. 1997;156(5):1640-6.
Johnson SB. Tracheobronchial injury. Seminars in thoracic and cardiovascular surgery. 2008;20(1):52-7.
McGonigal MD, Schwab CW, Kauder DR, Miller WT, Grumbach K. Supplemental emergent chest computed tomography in the management of blunt torso trauma. The Journal of trauma. 1990;30(12):1431-4; discussion 4-5.
Paydar S, Johari HG, Ghaffarpasand F, Shahidian D, Dehbozorgi A, Ziaeian B, et al. The role of routine chest radiography in initial evaluation of stable blunt trauma patients. The American journal of emergency medicine. 2012;30(1):1-4.
Mayo JR, Aldrich J, Muller NL. Radiation exposure at chest CT: A statement of the Fleischner Society. Radiology. 2003;228(1):15-21.