Acute Crit Care.  2024 May;39(2):323-326. 10.4266/acc.2021.01802.

Digital tomography in the diagnosis of a posterior pneumothorax in the intensive care unit

• Wellekens S
• Buls N
• De Mey J
• Van Nieuwenhove V
• Cant J
• Jonckheer J

• KMID: 2557250
• DOI: http://doi.org/10.4266/acc.2021.01802

Abstract

Portable chest radiography is a valuable tool in the intensive care unit. However, the supine position causes superposition of anatomical structures resulting in less reliable detection of certain abnormalities. Recently, a portable digital tomosynthesis (pDTS) prototype with a modified motorized x-ray device was developed. We aimed to compare the diagnostic value of pDTS to standard bedside chest radiography in the diagnosis of a posterior pneumothorax. A modified motorized x-ray device was developed to perform 15 radiographic projections while translating the x-ray tube 25 cm (10 cm ramp up and 15 cm during x-ray exposure) with a total radiation dose of 0.54 mSv. This new technique of pDTS was performed in addition to standard bedside chest x-ray in a patient with a confirmed posterior hydropneumothorax. The images were compared with the standard bedside chest x-ray and computed tomography (CT) images by two experienced radiologists. The posterior hydropneumothorax previously identified with CT was visible on tomosynthesis images but not with standard bedside imaging. Combining the digital tomosynthesis technique with the portable x-ray machine could increase the diagnostic value of bedside chest radiography for the diagnosis of posterior pneumothoraces while avoiding intrahospital transport and limiting radiation exposure compared to CT.

Keyword

Bedside chest X-ray; digital tomosynthesis; intensive care unit; posterior pneumothorax

Figure

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  Figure 1. (A) Computed tomography (CT) thorax on day 41 of admission showing subcutaneous emphysema and a pneumomediastinum (arrow). (B) Standard bedside chest X-ray. Arrow, pneumothorax at the left apex. (C) Standard bedside chest X-ray after drain insertion (left). Arrow, resolution of the pneumothorax at the left apex with drain in situ. (D) Standard bedside chest X-ray: pneumothorax at the right apex (arrow). (E) Standard bedside chest X-ray after drain insertion (right). Arrow, resolution of the pneumothorax at the right apex with drain in situ.

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  Figure 2. (A) Bedside portable digital tomosynthesis image showing a posterior pneumothorax on the right thorax (arrow). (B) Standard bedside chest radiography: no pneumothorax visible.

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