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Differentiating pyopneumothorax and peripheral lung abscess: chest ultrasonography
Fang-Chi Lin1, Chung-Wei Chou, Shi-Chuan Chang
1Department of Internal Medicine, Yuan Shan Veteran Hospital, National Yang-Ming University, Taipei, Taiwan, ROC.
The American Journal of the Medical Sciences
|June 18, 2004
Summary
Chest ultrasonography effectively differentiates pyopneumothorax from lung abscess using specific signs. These sonographic findings, including air-fluid levels and curtain signs, aid in accurate diagnosis and treatment planning.
Area of Science:
- Thoracic imaging
- Diagnostic ultrasonography
- Pulmonology
Background:
- Differentiating pyopneumothorax and lung abscess is clinically significant but challenging.
- Chest ultrasonography's role in this differentiation is not well-established.
- Sonographic features of hydropneumothorax are recognizable and may aid diagnosis.
Purpose of the Study:
- To evaluate the diagnostic utility of specific sonographic findings in distinguishing pyopneumothorax from lung abscess.
- To assess a panel of sonographic features characteristic of hydropneumothorax for differential diagnosis.
Main Methods:
- A case series of 16 patients with lung abscess and 19 with pyopneumothorax.
- Diagnosis confirmed by pus aspiration, clinical presentation, CT, radiography, and clinical course.
- Blinded readers analyzed sonographic features: air-fluid level, curtain sign, loss of gliding sign, and suspended microbubble sign.
Main Results:
- The presence of air-fluid level, curtain sign, loss of gliding sign, and suspended microbubble sign were valuable indicators.
- All four signs were present in 17/19 pyopneumothorax cases.
- Two or fewer signs were observed in 16/16 lung abscess cases.
- Wall characteristics, lesion shape, chest wall angle, and pleural separation also aided differentiation.
Conclusions:
- A panel of sonographic findings is highly valuable for differentiating pyopneumothorax from lung abscess.
- Ultrasonography offers a reliable, non-invasive method for distinguishing these thoracic conditions.