POINT-OF-CARE ULTRASOUND VERSUS CHEST RADIOGRAPHY FOR THE DETECTION OF PNEUMOTHORAX IN THE EMERGENCY DEPARTMENT: A REVIEW OF DIAGNOSTIC ACCURACY AND CLINICAL UTILITY

Pneumothorax is an important diagnosis in emergency medicine because delayed recognition can lead to respiratory compromise and, in severe cases, tension pneumothorax. Chest radiography has traditionally been one of the most commonly used initial imaging studies for suspected pneumothorax. However, point-of-care lung ultrasound has become increasingly incorporated into emergency and trauma evaluation because it can be performed rapidly at the bedside without radiation or patient transport. This review compares point-of-care ultrasound with chest radiography for detecting pneumothorax, focusing on sensitivity, specificity, speed, ultrasound findings, trauma applications, limitations, and practical emergency department use. Current evidence consistently demonstrates that lung ultrasound has greater sensitivity than portable supine chest radiography while maintaining similarly high specificity. A recent emergency department meta-analysis reported sensitivity of 79.4% for chest ultrasound compared with 48.1% for chest radiography, while specificity exceeded 99% for both methods. Although computed tomography remains the most sensitive imaging method for small or occult pneumothoraces, point-of-care ultrasound provides a rapid and effective bedside tool that can improve early recognition, particularly in trauma and critically ill patients. Ultrasound should complement rather than completely replace chest radiography because each modality provides different clinical information and ultrasound remains dependent on operator skill and patient factors.