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. 2019 Mar 4:14:9.
doi: 10.1186/s40248-019-0171-x. eCollection 2019.

Agreement between chest ultrasonography and chest X-ray in patients who have undergone thoracic surgery: preliminary results

Andrea Smargiassi #  1 , Riccardo Inchingolo #  1 , Marco Chiappetta  2 , Leonardo Petracca Ciavarella  2 , Stefania Lopatriello  1 , Giuseppe Maria Corbo  1   3 , Stefano Margaritora  2   3 , Luca Richeldi  1   3
Affiliations

Agreement between chest ultrasonography and chest X-ray in patients who have undergone thoracic surgery: preliminary results

Andrea Smargiassi et al. Multidiscip Respir Med. .

Abstract

Background: Chest Ultrasonography (chest US) has shown good sensibility in detecting pneumothorax, pleural effusions and peripheral consolidations and it can be performed bedside.

Objectives: The aim of the study was to analyze agreement between chest US and chest X-ray in patients who have undergone thoracic surgery and discuss cases of discordance.

Methods: Patients undergoing thoracic surgery were retrospectively selected. Patients underwent routinely Chest X-ray (CXR) during the first 48 h after surgery. Chest US have been routinely performed in all selected patients in the same date of CXR. Chest US operators were blind to both reports and images of CXR. Ultrasonographic findings regarding pneumothorax (PNX), subcutaneous emphysema (SCE), lung consolidations (LC), pleural effusions (PE) and hemi-diaphragm position were collected and compared to corresponding CXR findings. Inter-rater agreement between two techniques was determined by Cohen's kappa-coefficient.

Results: Twenty-four patients were selected. Inter-rater agreement showed a moderate magnitude for PNX (Cohen's Kappa 0.5), a slight/fair magnitude for SCE (Cohen's Kappa 0.21), a fair magnitude for PE (Cohen's Kappa 0.39), no agreement for LCs (Cohen's Kappa 0.06), high levels of agreement for position of hemi-diaphragm (Cohen's Kappa 0.7).

Conclusion: Analysis of agreement between chest X-ray and chest US showed that ultrasonography is able to detect important findings for surgeons. Limitations and advantages have been found for both chest X-ray and chest US. Knowing the limits of each one is important to really justify and optimize the use of ionizing radiations.

Keywords: Chest X-ray; Chest ultrasound; Innovative biotechnologies; Thoracic surgery; Ultrasonography.

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Conflict of interest statement

IRB (Institutional Review Board) approval of “Fondazione Policlinico Universitario A. Gemelli IRCCS” was obtained for this retrospective analysis IRB: P/ CE 5857/19.Not applicable.No competing interests have to be reported by the authors in relation to this work. AS and LR are Associate Editors of Multidisciplinary Respiratory Medicine.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
A case of subcoutaneous emphysema localized only around the surgical wound. It has been missed by chest US because of local medications
Fig. 2
Fig. 2
Chest x-ray performed before (on the right) and after (on the left) bronchoscopy. Chest x-ray reported the presence of loculated pleural effusion, which was correctly identified as obstructive atelectasis by Chest US (see Fig. 4)
Fig. 3
Fig. 3
On the right: a case of elevated hemidiaphragm detected by both chest US and chest X-ray. On the left: Elevated left hemidiagram not easily detectble by chest x-ray because of concomitant pleural effusion and basal lung consolidation
Fig. 4
Fig. 4
The same case of Fig. 2. Chest US reported LC compatible with obstructive atelectasis and reduction of volume of the hemithorax. Chest X-ray was required for a panoramic view
See this image and copyright information in PMC

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