{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T11:21:03Z","timestamp":1767093663882,"version":"3.48.0"},"reference-count":25,"publisher":"Medical Communications Sp. z.o.o.","issue":"102","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Ultrason"],"abstract":"<jats:p>Aim: Pneumothorax is a potentially life-threatening condition whose diagnosis can be challenging.\nUltrasound chest examination is generally fast and user-friendly, but in non-expert hands or with\nuncooperative patients, it may still be difficult and time-consuming. Adding another tool to support the suspicion of pneumothorax might be useful, potentially enhancing the diagnostic accuracy of standard ultrasound chest examination. We evaluated the feasibility of standardized bilateral ultrasound image comparison as a potential new tool for pneumothorax diagnosis. Materials and methods: We enrolled 60 subjects (30 with pneumothorax and 30 controls) and collected bilateral ultrasound images of their chests (each image contained one frame from the left lung and one from the right lung). Ten physicians (eight blinded to diagnosis) divided into five groups according to expertise evaluated the images for potential grayscale differences and\/or horizontal artifacts between the two frames. All images were then analyzed with image analysis software for grayscale pixel assessment (one sub-analysis for the entire area under the pleural line, one for a 100-pixel-wide rectangle under the pleural line). Results: All clinicians achieved good results in terms of diagnostic accuracy and inter-operator reliability, even those unexperienced in ultrasound. Mean, range, and median grayscale pixel ratio between the pneumothorax side and the healthy side in a single patient proved to be the most reliable parameters, reaching excellent sensitivity and specificity. Combining these parameters proved to be an excellent diagnostic tool (ROC area under curve = 1.00, p-value = 0.02). Conclusions: Standardized bilateral thoracic ultrasound image comparison may be a potential new tool for the diagnosis of pneumothorax.<\/jats:p>","DOI":"10.15557\/jou.2025.0024","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T11:15:35Z","timestamp":1767093335000},"source":"Crossref","is-referenced-by-count":0,"title":["Standardized bilateral thoracic ultrasound image comparison as a tool for the diagnosis of pneumothorax: a pilot exploratory study"],"prefix":"10.15557","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7163-2270","authenticated-orcid":false,"given":"Guido","family":"Levi","sequence":"first","affiliation":[{"name":"Pulmonology Unit, ASST Spedali Civili di Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7250-7028","authenticated-orcid":false,"given":"Chiara","family":"Rocchetti","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, ASST Spedali Civili di Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4846-8529","authenticated-orcid":false,"given":"Riccardo Maria","family":"Inciardi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8200-4336","authenticated-orcid":false,"given":"Michela","family":"Bezzi","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, ASST Spedali Civili di Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6563-4942","authenticated-orcid":false,"given":"Laura","family":"Pini","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1185-9465","authenticated-orcid":false,"given":"Claudio","family":"Tantucci","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0753-5572","authenticated-orcid":false,"given":"Giampietro","family":"Marchetti","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, ASST Spedali Civili di Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6250","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"1. Tschopp JM, Bintcliffe O, Astoul P, Canalis E, Driesen P, Janssen J et al.: ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax. Eur Respir J 2015; 46: 321\u2013335. doi: 10.1183\/09031936.00219214.","DOI":"10.1183\/09031936.00219214"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"2. Husain LF, Hagopian L, Wayman D, Baker WE, Carmody KA: Sonographic diagnosis of pneumothorax. J Emerg Trauma Shock 2012; 5: 76\u201381. doi: 10.4103\/0974-2700.93116.","DOI":"10.4103\/0974-2700.93116"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"3. Metzler EK, Everl\u00f8ff N, Juul AD, Laursen CB, Graumann O, Pietersen PI: Value of focused lung ultrasound in diagnosing and monitoring pneumothorax after CT-guided lung biopsy. J Ultrasound 2025; 28: 11\u201318. doi: 10.1007\/s40477-025-00998-w.","DOI":"10.1007\/s40477-025-00998-w"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"4. Sieber S, Garbe J, B\u00f6hm S, Eisenmann S: Pneumothorax detection with thoracic ultrasound as the method of choice in interventional pulmonology \u2013 a retrospective single-center analysis and experience. BMC Pulm Med 2023; 23: 227. doi: 10.1186\/s12890-023-02511-7.","DOI":"10.1186\/s12890-023-02511-7"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"5. Brims FJ, Davies HE, Lee YC: Respiratory chest pain: diagnosis and treatment. Med Clin North Am 2010; 94: 217\u2013232. doi:10.1016\/j.mcna.2010.01.003.","DOI":"10.1016\/j.mcna.2010.01.003"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"6. Sperandeo M, Filabozzi P, Varriale A, Carnevale V, Piattelli ML, Sperandeo G et al.: Role of thoracic ultrasound in the assessment of pleural and pulmonary diseases. J Ultrasound 2008; 11: 39\u201346. doi: 10.1016\/j.jus.2008.02.001.","DOI":"10.1016\/j.jus.2008.02.001"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"7. Asrani A, Kaewlai R, Digumarthy S, Gilman M, Shepard JA: Urgent findings on portable chest radiography: what the radiologist should know \u2013 review. AJR Am J Roentgenol 2011; 196(6 Suppl): S45\u2013S61. doi: 10.2214\/AJR.09.7170.","DOI":"10.2214\/AJR.09.7170"},{"key":"ref7","unstructured":"8. Fraser RS, M\u00fcller NL, Colman N, Pare PD: Diagnosis of Diseases of the Chest. 4th ed. Philadelphia: WB Saunders, 1991; p. 2741\u20132750."},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"9. Bandelli GP, Levi G, Quadri F, Marchetti GP: \u201cElasto-lung point\u201d: A new tool for the sonographic confirmation of pneumothorax. Clin Respir J 2020; 14: 758\u2013762. doi: 10.1111\/crj.13193.","DOI":"10.1111\/crj.13193"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"10. Berry L, Rehnberg L, Groves P, Knight M, Stewart M, Dushianthan A: Lung ultrasound in critical care: a narrative review. Diagnostics (Basel) 2025; 15: 755. doi: 10.3390\/diagnostics15060755.","DOI":"10.3390\/diagnostics15060755"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"11. Quarato CMI, Mirijello A, Bocchino M, Feragalli B, Lacedonia D, Rea G et al.: Low diagnostic accuracy of transthoracic ultrasound for the assessment of spontaneous pneumothorax in the emergency setting: a multicentric study. J Clin Med 2024; 13: 4861. doi: 10.3390\/jcm13164861.","DOI":"10.3390\/jcm13164861"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"12. Soldati G, Testa A, Sher S, Pignataro G, La Sala M, Silveri NG: Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest 2008; 133: 204\u2013211. doi: 10.1378\/chest.07-1595.","DOI":"10.1378\/chest.07-1595"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"13. Lichtenstein DA, Mezi\u00e8re G, Lascols N, Biderman P, Courret JP, Gepner A et al.: Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005; 33: 1231\u20131238. doi: 10.1097\/01.ccm.0000164542.86954.b4.","DOI":"10.1097\/01.CCM.0000164542.86954.B4"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"14. Slater A, Goodwin M, Anderson KE, Gleeson FV: COPD can mimic the appearance of pneumothorax on thoracic ultrasound. Chest 2006; 129: 545\u2013550. doi: 10.1378\/chest.129.3.545.","DOI":"10.1378\/chest.129.3.545"},{"key":"ref14","unstructured":"15. Ball CG, Kirkpatrick AW, Feliciano DV: The occult pneumothorax: what have we learned? Can J Surg 2009; 52: E173\u2013E179."},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"16. Ding W, Shen Y, Yang J, He X, Zhang M: Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest 2011; 140: 859\u2013866. doi: 10.1378\/chest.10-2946.","DOI":"10.1378\/chest.10-2946"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"17. Chung MJ, Goo JM, Im JG, Cho JM, Cho SB, Kim SJ: Value of high-resolution ultrasound in detecting a pneumothorax. Eur Radiol 2005; 15: 930\u2013935. doi: 10.1007\/s00330-004-2518-7.","DOI":"10.1007\/s00330-004-2518-7"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"18. Malla M, Purna Shrestha A, Prasad Shrestha S, Shrestha R: Diagnostic accuracy of bedside lung ultrasound in detecting traumatic pneumothorax by novice physicians in the Emergency Department of a Tertiary Care Hospital of Nepal. Emerg Med Int 2024; 2024: 9956637. doi: 10.1155\/2024\/9956637.","DOI":"10.1155\/2024\/9956637"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"19. Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E et al.: Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department. Cochrane Database Syst Rev 2020; 7: CD013031. doi: 10.1002\/14651858.CD013031.pub2.","DOI":"10.1002\/14651858.CD013031.pub2"},{"key":"ref19","unstructured":"20. ImageJ [computer program]. Version 1.42q; Bethesda (MD): U.S. National Institutes of Health. Available from: https:\/\/imagej.net\/ij\/ [access: 04.05.2025]."},{"key":"ref20","unstructured":"21. Russ JC: The Image Processing Handbook. 7th ed. Boca Raton (FL): CRC Press; 2016."},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"22. Schneider CA, Rasband WS, Eliceiri KW: NIH Image to ImageJ: 25 years of image analysis. Nat Methods 2012; 9: 671\u2013675. doi: 10.1038\/nmeth.2089.","DOI":"10.1038\/nmeth.2089"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"23. Kalkanis A, Varsamas C, Gourgoulianis K: Correlation of pleural effusions\u2019 grayscale sonographic parameters with fluid\u2019s analysis results. J Thorac Dis 2017; 9: 543\u2013546. doi: 10.21037\/jtd.2017.03.31.","DOI":"10.21037\/jtd.2017.03.31"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"24. Yang C, Zhao H, Wang A, Li J, Gao J: Comparison of lung ultrasound assisted by artificial intelligence to radiology examination in pneumothorax. J Clin Ultrasound 2024; 52: 1051\u20131055. doi: 10.1002\/jcu.23756.","DOI":"10.1002\/jcu.23756"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"25. Kossoff J, Duncan S, Acharya J, Davis D: Automated Analysis of ultrasound for the diagnosis of pneumothorax: a systematic review. Cureus 2024; 16: e72896. doi: 10.7759\/cureus.72896.","DOI":"10.7759\/cureus.72896"}],"container-title":["Journal of Ultrasonography"],"original-title":[],"deposited":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T11:15:39Z","timestamp":1767093339000},"score":1,"resource":{"primary":{"URL":"https:\/\/jultrason.pl\/index.php\/issues\/volume-25-no-102\/standardized-bilateral-thoracic-ultrasound-image-comparison-as-a-tool-for-the-diagnosis-of-pneumothorax-a-pilot-exploratory-study"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":25,"journal-issue":{"issue":"102","published-online":{"date-parts":[[2025,9,30]]}},"URL":"https:\/\/doi.org\/10.15557\/jou.2025.0024","relation":{},"ISSN":["2084-8404","2451-070X"],"issn-type":[{"value":"2084-8404","type":"print"},{"value":"2451-070X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,30]]}}}