Efficacy of thoracic ultrasonography in thoracostomy tube removal

Abstract

Background: Tube thoracostomy is the most commonly performed procedure in thoracic surgery. Follow- up with daily chest X-ray is performed for both pneumothorax patients and postoperative patients, but residual pneumothorax can often be missed on portable imaging in supine position. This study aimed to evaluate the efficacy and safety of ultrasonography and chest X-ray by comparing these two methods in chest tube removal and thus determine whether ultrasonography is suitable for routine use in thoracic surgery clinics. Materials and Methods: This prospective study included a total of 28 patients who underwent tube thoracostomy in our center between December 2019 and December 2020 due to spontaneous pneumothorax (n = 16) or after wedge resection for different indications (n = 12). Chest X-ray and thoracic ultrasonography were performed before and after chest tube removal. The efficacy of thoracic ultrasonography compared to chest X-ray in the detection of residual pneumothorax was evaluated using specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV). Results: Twenty-four (85.7%) of the patients were male. The mean age was 40.25 ± 19.75 years (median, 39.5). Tube thoracotomy was performed on the right side in 18 patients (64.3%). Ultrasonography before tube removal had a PPV of 50%, NPV of 100%, sensitivity of 100%, and specificity of 96.3%. After tube removal, ultrasonography had a PPV of 100%, NPV of 96%, sensitivity of 75%, and specificity of 100%. Conclusions: The results of our comparison of chest X-ray and thoracic ultrasonography examinations performed before and after chest tube removal showed that thoracic ultrasonography was as effective as chest X-ray and can be used safely in clinics.