The use of B- and M-mode sonography for detection of pneumothorax has been well described and studied. It is now widely incorporated by sonographers, emergency physicians, trauma surgeons, radiologists, and critical care specialists worldwide. Lung sonography can be performed rapidly at the bedside or in the prehospital setting. It is more sensitive, specific, and accurate than plain chest radiography. The use of color and power Doppler sonography as an adjunct to B- and M-mode imaging for detection of pneumothorax has been described in a small number of studies and case reports but is much less widely known or used. Color and power Doppler imaging may be used for confirmation of the presence or absence of lung sliding detected with B-mode sonography. In this article, we examine the physics behind Doppler sonography as it applies to the lung, technique, an actual case, and the past literature describing the use of color and power Doppler sonography for the detection of pneumothorax.
It is surprising that the use of color or power Doppler as an adjunct to B- and M-mode detection of pneumothorax is not more widely incorporated or broadcast. Neither is included, or even considered, in several recent lung sonographic protocols for trauma and critical care, such as SESAME (sequential emergency sonography assessing the mechanism or origin of severe shock of indistinct cause), BLUE (bedside lung ultrasound in emergencies), and FALLS (fluid administration limited by lung sonography).[16, 17] Furthermore, Doppler sonography is not mentioned in several recently published guidelines and reviews.[18-20] We believe that color or power Doppler sonography as an adjunct to B- and M-mode sonography for diagnosis of pneumothorax represents a technical innovation of which sonographers should be aware.