Journal reading

Detection of Pneumotorax with Ultrasound

Mustika tri handayani

1320221135
Pembimbing : dr.novita elyana, sp.Rad

Anatomi pleura

Pleura
merupakan
membran
serosa
yang
membungkus paru-paru dan melapisi dinding
rongga toraks.
Pleura terdiri atas dua lapisan yaitu pleura
visceralis dan pleura parietalis

 Pleura
viseral

menyelimuti parenkim
paru, termasuk fisura
interlobaris
pleura parietal
membatasi
dinding
dada yang tersusun
dari otot dada dan
tulang
iga,
serta
diafragma,
mediastinum
dan
meluas
sampai
pangkal servikal


Vaskularisasi pleura
Pleura parietal divaskularisasi oleh Aa. Intercostalis,
a.mammaria, a.musculophrenica. Sedangkan pleura
visceralisnya mendapatkan vskularisasi dari Aa.
Bronchiales. Dan vena-venanya bermuara pada system
vena dinding thorax
Innervasi Pleura
Pleura parietalis pars costalis diinervasi oleh Nn.
Intercostalis. Pleura paritalis pars diaphramatica bagian
perifer diinervasi oleh Nn. Intercostales, sedangkan
bagian central oleh n.phrenicus.
Pleura visceralis diinervasi oleh serabut afferent
otonom dari plexus pulmonalis

Aliran limfatik
Dari pleura viseral dialirkan ke kelenjar
limfe pulmoner di hilus
Aliran limfe Dari pleura parietal anterior
dialirkan melalui jaringan interkosta.
Aliran limfe pleura diafragmatika menuju
kelenjar limfe mediastinum bawah.
Limfe di pleura parietal bawah mengalir
ke kelenjar limfe retroperitoneal di regio
adrenal dan ginjal

 Pleura visceral dan pleura parietal

terpisah oleh rongga pleura (cavitas
pleuralis). Rongga ini mengandung
sejumlah tertentu cairan pleura
Cairan cavum pleura sangat sedikit,
sekitar 0,3 ml/ kg. Cairan pleura ini
berfungsi sebagai pelumas untuk
memungkinkan kedua lapisan pleura
bergerak satu dengan yang lain
dengan sedikit pergesekan. Gerakan
pernafasan
dan
gravitasi
kemungkinan besar ikut mengatur
jumlah produksi dan reabsorpsi
cairan cavum pleura. Reabsorpsi
terjadi terutama pada pembuluh
limfe
pleura
parietalis
dengan
kecepatan
0,1
sampai
0,15
ml/kg/jam

fisiologi
Rongga intrapleura ini selalu bertekanan negatif mencegah
paru menjauhi dinding thoraks paru dapat mengembang saat
respirasi
Tekanan pada rongga pleura pada akhir inspirasi - 4 s/d 8 cm H2O
dan pada akhir ekspirasi 2 s/d 4 cm H2O.
Pada waktu inspirasi tekanan intrapleura lebih negatif daripada
tekanan intrabronkial maka paru mengembang mengikuti
gerakan dinding toraks sehinga udara dari luar dengan tekanan
permulaan nol, akan terisap masuk melalui bronkus hingga
mencapai alveol (Gas berjalan dari suatu tempat bertekanan
tinggi ke tempat bertekanan rendah)
Pada saat ekspirasi, dinding dada menekan rongga dada sehingga
tekanan intrapleura akan lebih tinggi daripada tekanan udara
alveol ataupun di bronkus, akibatnya udara akan ditekan keluar
melalui bronkus

Detection of pneumotorax with

ultrasound
Pnemothorax is an abnormal
collection of air between the
visceral
Today, Considering
pneumotorax
and parietal pleural layers of
the is an
emergency because
First
detected
dan
lung.
its complication. And
treated by a 15th
century
physician
from Anatolia named
Serefeddin
Detected
by finding
Sabuncuoglu.

signal a puncture in
the pleura. shortness
of breath, cough, and
hemoptysis

Treatmen
t called
mihceme

the most etiology is

trauma so team
anesthesia looking
for how quickly to
diagnose
pneumotorax

traditionally

Patient history
Clinical
examination
Rontgen

But
This detection are not
readily available while
patients are
under general
anesthesia

CT Scan

Ultrasonography
(USG)

Advantages of USG
Comparing with CT Scan :
- Ct scan is not feasible during general anesthesia in
operating room USG portable
- CT scan need for a radiation technologist to perform the
scan, the need for physician interpretation
- CT scan gives the greatest radiation exposure to the
patient
Comparing with Rontgen:
- ultrasonography was a much more sensitive screening
test for detection of pneumothorax than supine chest
radiography in the trauma patient.
- Rontgen gives radiation exposure to patient
the time to diagnose pneumothorax was about 7
minutes for ultrasonography vs 80 minutes in the x-ray

Performing lung
scans

Prepared equipment :
Probe linear with high frequency 5 mHz.
Prepared patients :
The position
if the supine position, the anterior aspect is scanned
If posterior section of the chest wants to be
scanned the patient position is the lateral
decubitus position
- If there is a penetrating injuriies the lateral
aspect of the chest should ideally be scanned in the
lateral position

Ultrasonographic Terms
To interpret these scans, each provider must be
familiar with the characteristic signs produced by
ultrasonography:
B Mode : brightness mode corresponds to
amplitude of reflected sounds
M mode : or motion mode Looking at M-mode
processing is much like reading an ECG strip, and
it reflects activity over time.

Table. Terms and Definitions

Associated With Ultrasonographic
Detection of Pneumothorax

Normal sign that can be found in

lung scan
Bat sign

Lung slidding

Seashore sign

Pleural line ; A line; B line

Abnormal sign =
pneumothorax
Strathospere Sign atau
Barcode Sign

Lung point

Barcode sign with lung point

Algorithm for lung scan

Conclusion
Sonographic diagnosis of pneumothorax is rapid,
accurate, and easily
The efficacy of ultrasonography as a tool for assessing
and diagnosing abnormalities in the chest, including
pneumothorax, has been demonstrated and has been
adopted by our emergency medicine, critical care,
pulmonary, trauma, and radiology colleagues.
The advantages of ultrasonography in diagnosing
pneumothorax show tremendous value to anesthesia
providers for use in the operating room
Incorporating it into anesthesia practice seems prudent
and beneficial.

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