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CC BY-NC-ND 4.0 · AJP Rep 2024; 14(03): e239-e243
DOI: 10.1055/a-2415-5318
Case Report

Distinction between Pneumothorax and Pneumomediastinum Using Point of Care Ultrasound (POCUS): Role of Still Lung Point

Anna E. Sagaser
1   Section of Neonatology, Department of Pediatrics, Women and Infants Hospital of Rhode Island, Brown University, Providence, Rhode Island
,
Ashley Reeves
1   Section of Neonatology, Department of Pediatrics, Women and Infants Hospital of Rhode Island, Brown University, Providence, Rhode Island
,
Tamara Arnautovic
2   Division of Neonatology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
,
Juan Sanchez-Esteban 
1   Section of Neonatology, Department of Pediatrics, Women and Infants Hospital of Rhode Island, Brown University, Providence, Rhode Island
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Abstract

The rapid identification and management of air leak syndrome in the neonatal intensive care unit is critical to prevent and/or minimize short- and long-term complications. Traditionally, chest X-ray is used to diagnose pneumothorax or pneumomediastinum. However, point-of-care ultrasound is increasingly being used for procedural and diagnostic purposes. Current ultrasound guidelines recommend specific criteria to diagnose pneumothorax in newborns including sharp A-lines, absence of B-lines, lack of shimmering of the pleural line, and the presence of a lung point. Pneumomediastinum may have similar ultrasound characteristics. In this case report, we present two cases of pneumomediastinum in newborns, describe the associated ultrasound findings, and review some of the criteria to differentiate from pneumothorax, including the presence of a still lung point. A high index of suspicion for pneumomediastinum should be maintained when using ultrasound to diagnose air leak given the overlapping sonographic features with pneumothorax. This distinction is of particular importance if evacuation of air by needle thoracentesis or the placement of a chest tube is under consideration.

Keywords

POCUS - pneumothorax - pneumomediastinum - lung sliding - ultrasound - air leak syndrome - newborn - lung point


Publication History

Received: 10 May 2024

Accepted: 09 September 2024

Accepted Manuscript online:
14 September 2024

Article published online:
08 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Carey B. Neonatal air leaks: pneumothorax, pneumomediastinum, pulmonary interstitial emphysema, pneumopericardium. Neonatal Netw 1999; 18 (08) 81-84
    CrossrefPubMedGoogle Scholar
  • 2 Cagle KJ. Pneumomediastinum in the neonate. Neonatal Netw 2014; 33 (05) 275-282
    CrossrefPubMedGoogle Scholar
  • 3 Jhaveri V, Vali P, Giusto E, Singh Y, Lakshminrusimha S. Pneumothorax in a term newborn. J Perinatol 2024; 44 (04) 465-471
    CrossrefPubMedGoogle Scholar
  • 4 Liu J, Copetti R, Sorantin E. et al. Protocol and guidelines for point-of-care lung ultrasound in diagnosing neonatal pulmonary diseases based on international expert consensus. J Vis Exp 2019; (145) DOI: 10.3791/58990.
    CrossrefPubMedGoogle Scholar
  • 5 Saracino C, Tessaro M. Pneumomediastinum as a sonographic mimic of pneumothorax. J Ultrasound Med 2015; 34 (08) 1521-1522
    CrossrefPubMedGoogle Scholar
  • 6 Klavžar P, Plut D. Ultrasound as a problem solver to diagnose pneumomediastinum in an infant. Acta Radiol Open 2021; 10 (08) 20 584601211030657
    PubMedGoogle Scholar
  • 7 Young Jung A, Yang I, Sun Go H. et al. Imaging neonatal spontaneous pneumomediastinum using ultrasound. J Med Ultrason 2014; 41: 45-49
    CrossrefPubMedGoogle Scholar
  • 8 Küng E, Habrina L, Berger A, Werther T, Aichhorn L. Diagnosing pneumomediastinum in a neonate using a lung ultrasound. Lancet 2021; 398 (10303): e13
    CrossrefPubMedGoogle Scholar
  • 9 Matsumoto T, Matano H. The still lung point: new sonographic evidence for pneumomediastinum. Am J Emerg Med 2016; 34 (02) 344.e1-344.e2
    CrossrefPubMedGoogle Scholar
  • 10 Zachariah S, Gharahbaghian L, Perera P, Joshi N. Spontaneous pneumomediastinum on bedside ultrasound: case report and review of the literature. West J Emerg Med 2015; 16 (02) 321-324
    CrossrefPubMedGoogle Scholar
  • 11 Van Gelderen WF. Ultrasound diagnosis of an atypical pneumomediastinum. Pediatr Radiol 1992; 22 (06) 469
    CrossrefPubMedGoogle Scholar
  • 12 Montero-Gato J, Rodeño-Fernández L, Serna-Guerediaga I, Aguirre-Unceta-Barrenechea A, Aguirre-Conde A, Perez-Legorburu A. Ultrasound of pneumothorax in neonates: diagnostic value of the anterior transverse plane and of mirrored ribs. Pediatr Pulmonol 2022; 57 (04) 1008-1014
    CrossrefPubMedGoogle Scholar
  • 13 Raimondi F, Yousef N, Migliaro F, Capasso L, De Luca D. Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res 2021; 90 (03) 524-531
    CrossrefPubMedGoogle Scholar
  • 14 Aichhorn L, Küng E, Habrina L. et al. The role of lung ultrasound in the management of the critically ill neonate-a narrative review and practical guide. Children (Basel) 2021; 8 (08) 628
    CrossrefPubMedGoogle Scholar
  • 15 Conlon TW, Nishisaki A, Singh Y. et al. Moving beyond the stethoscope: diagnostic point-of-care ultrasound in pediatric practice. Pediatrics 2019; 144 (04) e20191402
    CrossrefPubMedGoogle Scholar
  • 16 Kurepa D, Zaghloul N, Watkins L, Liu J. Neonatal lung ultrasound exam guidelines. J Perinatol 2018; 38 (01) 11-22
    CrossrefPubMedGoogle Scholar