Preliminary Diagnosis: Chest Tube Management/Assessment
I. What imaging technique is first-line for this diagnosis?
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PA and lateral view of the chest
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A single AP view of the chest may be used if a two viewz cannot be obtained.
II. Describe the advantages and disadvantages of this technique for diagnosis of chest tube management/assessment.
Advantages
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Relatively inexpensive
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Quick imaging modality
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Highly portable
Disadvantages
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Less adept in detailing any underlying primary parenchymal and pleural process or any secondary complications compared with CT imaging.
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Less specific and accurate in detailing the position of the chest tube compared with CT imaging.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to plain radiography exist.
IV. What alternative imaging techniques are available?
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Noncontrast CT of the chest
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Ultrasound imaging
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of chest tube management/assessment.
Noncontrast CT of the chest
Advantages
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Highly sensitive and specific in detailing the approach, course, and distal tip of the chest tube
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Able to accurately localize the surrounding soft tissue, osseous, and vascular structures when placing the chest tube
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More sensitive and specific in detailing and characterizing any underlying pulmonary processes or any secondary complications
Disadvantage
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Exposes patients to large amounts of ionizing radiation and is less portable
Ultrasound imaging
Advantages
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Does not expose patients to ionzing radiation.
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Highly portable
Disadvantages
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Unable to identify structures posterior to air and bone as sonographic waves cannot travel through those media.
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Less sensitive and specific in detailing any underlying primary pulmonary processes or secondary complications compared with CT imaging
VI. What are the contraindications for the alternative imaging techniques?
Noncontrast CT of the chest
May be contraindicated in pregnant patients
Ultrasound imaging
No specific contraindications to ultrasound imaging exist.
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