The value of a normal test result

This week I had a infrequent patient in, last seen in 2014, generally fit and well, non-smoking 35year old male.  He presented with left sided sharp chest pain that had come on suddenly while walking on the beach 36hours prior.  He rated the pain as 5/10, worse with deep inspiration and cough, relieved by lying down. There were no fever, sweats, productive cough or other infection symptoms. On examination normal RR, HR, BP, SpO2 and chest clear to auscultation and percussion. He is a tall, skinny man and with the other normal findings and history, a spontaneous small pneumothorax is a differential. Previously I would have sent this man for an erect CXR but with ultrasound there in the room we can look directly.

alines
Normal A-Line Lung ultrasound profile between two anterior rib spaces, the Bat Wing sign. Normal pleural sliding on video “ants marching”

So reassured about an absence of pneumothorax there was reassurance, assumption this was chest wall/intercostal muscle pain and a safety net plan for follow up if needed.

I called the patient 48hours post their consultations and all symptoms had resolved.

By having US available in the room, the patient was saved a trip to the radiologist, Medicare saved the cost of a radiograph and I was saved time following up the result.  Ruling out of pneumothorax with POCUS is one of the uses that has the highest specificity with sensitivity 86–98% and specificity 97–99%.

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Author: gppocus

Urban general practioner in Melbourne, Australia

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