Comparison between chest ultrasound (CUS) and chest radiography (CXR) in pneumothorax diagnosis: a literature review

Abstract

Thoracic injuries include 25% of mortalities in traumatic cases and are associated with a 40% mortality rate. Early diagnosis of pneumothorax in thoracic traumas can decrease the mortality rate and the resultant burden significantly. Diagnosis accuracy is crucial for the management and treatment of pneumothorax since that carries significant morbidity and mortality rates. More than 90% of injury deaths occur in low- and middle-income countries, where the World Health Organization recognizes injuries as a neglected epidemic with the least prepared healthcare systems to handle the trauma burden. Over the past decades, computed tomography (CT) scans have been the gold standard for pneumothorax diagnosis. Even though this diagnostic tool is highly accurate in the detection of intrathoracic injuries, patients undergoing CT scan examination receive a high radiation dose. This study aims to review and comprehend the comparison between chest ultrasound (CUS) and chest radiography (CXR) as a diagnostic tool for pneumothorax. CUS is non-invasive, affordable, and does not pose an ionizing radiation risk. It offers dynamic procedures that can be done at the patient's bedside and can also be used to guide procedures. Previous systematic reviews and meta-analyses showed the diagnostic accuracy of CUS was higher than supine CXR for pneumothorax detection. Patients in some health care centers undergo percutaneous transthoracic needle interventions for ongoing care, including a follow-up chest X-ray (CXR) to detect pneumothorax. In spite of the adjustment for possible sources of heterogeneity, CUS is more sensitive and specific than CXR as the detection modality of pneumothorax. Some important factors, including operator experience, patient demographics, frequency, signs, and ultrasound probes, could be associated with the accuracy of CUS in identifying and diagnosing pneumothorax.