J Vet Sci.  2018 Sep;19(5):660-666. 10.4142/jvs.2018.19.5.660.

Usefulness of transthoracic lung ultrasound for the diagnosis of mild pneumothorax

• Hwang TS
• Yoon YM
• Jung DI
• Yeon SC
• Lee HC

• KMID: 2420935
• DOI: http://doi.org/10.4142/jvs.2018.19.5.660

Abstract

The aim of the present study was to investigate the diagnostic accuracy of ultrasonography in the detection of mild pneumothorax using computed tomography (CT) in dogs. Nine adult healthy beagles were included in the study. A thoracic tube was inserted into pleural space at the left thoracic wall, and each dog underwent the examinations in the order of CT, lung ultrasonography, and radiography before the infusion of room air into the pleural space. Two, 3, and 5 mL/kg infusions of room air were sequentially introduced into the pleural space and CT, lung ultrasound, and radiography examinations were performed. Sonographic signs included A-lines, stratosphere, lung sliding, lung point, lung pulse, and reverse sliding signs. Radiographs were evaluated for the absence or presence of a pneumothorax. Lung ultrasound results were more accurate than radiography results for the detection of mild pneumothorax. The overall sensitivity of the sonographic reverse sliding sign was higher than that of other sonographic signs, and its specificity was 100% for detection of mild pneumothorax. Thus, the reverse sliding sign is useful when using lung ultrasonography for diagnosis of mild pneumothorax.

Keyword

dogs; lung ultrasonography; pneumothorax; reverse sliding sign

MeSH Terms

Adult
Animals
Diagnosis*
Dogs
Humans
Lung*
Pneumothorax*
Radiography
Sensitivity and Specificity
Thoracic Wall
Ultrasonography*

Figure

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  Fig. 1 Diagnosis of pneumothorax by using computed tomography (CT). (A) Pneumothorax (arrows) of the cranial thorax on axial CT image. (B) Pneumothorax (arrows) of the caudal thorax on axial CT image.

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  Fig. 2 Transthoracic lung ultrasound scan areas. Diagram illustrating location criteria used for dividing each dog's hemithorax into four quadrants, using the shoulder joint as the limit between the ventral and dorsal quadrants and the sixth intercostal space as the limit between the cranial and caudal quadrants.

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  Fig. 3 Normal lung transthoracic ultrasound image. Horizontal A-lines are present in healthy dogs. R, rib; P, pleural surface; A, reverberation artefact of the pleural surface.

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  Fig. 4 The time-motion mode objectifies the lung slide (A), stratosphere (B), lung pulse (C), and lung point (D) signs. (A) Below the pleural line, lung sliding generates a homogeneous granular pattern. (B) Parallel horizontal lines above and below the pleural line, resemble a ‘barcode’ and indicates the absence of lung sliding. (C) Vertical movement of pleural lines synchronous to the cardiac rhythm (arrows). (D) The sudden inspiratory appearance of a granular pattern beneath the pleural line (arrow).

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  Fig. 5 The two-dimensional mode objectifies normal lung (A and B) and reverse sliding sign (C and D) in ultrasound images. (A) During expiration, horizontal A-lines (arrowhead) were present in healthy dogs. (B) During inspiration, A-lines showed lung sliding in the caudal direction (arrowhead). (C) During expiration, caudal lung lobe (arrowhead) was present. A minimal amount of trapped pleural air may remain in the caudodorsal thorax in the area of the adjacent rib (arrow). The trapped air visualized as A-line in this area. (D) During inspiration, the trapped pleural air escapes because of an increase in the size of the thoracic cavity. The half image under the transducer shows lung slide in the caudal direction (arrowhead), while the other half of the image shows the sliding sign in the opposite direction in the left caudodorsal thorax (arrow). Asterisks, left lateral hepatic lobe.

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  Fig. 6 A theoretical explanation of the reverse sliding sign. (A) During expiration, a minimal amount of pleural air (asterisk) may remain in the caudodorsal thorax in the area of the adjacent rib in sternal recumbency dogs. (B) During inspiration, trapped pleural air (asterisk) escapes because of increase in the size of the thoracic cavity; that is, the lung is inflated in the caudal direction during inspiration, while trapped air escapes in a direction opposite to that of lung sliding in the caudodorsal thorax.

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