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Related Experiment Videos

An objective method to measure and manage occult pneumothorax.

R R Garramone1, L M Jacobs, P Sahdev

  • 1Department of EMS/Trauma, Hartford Hospital, Connecticut 06115.

Surgery, Gynecology & Obstetrics
|October 11, 1991
PubMed
Summary

Occult pneumothoraces found on abdominal CT scans in trauma patients are often missed on chest X-rays. Small pneumothoraces (<5 X 80 mm) may be managed with observation, while larger ones may require intervention.

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Area of Science:

  • Radiology
  • Trauma Surgery
  • Thoracic Medicine

Background:

  • Multisystem trauma patients often undergo abdominal computed tomographic (CT) scans.
  • Incidental pneumothoraces are sometimes discovered on these scans, which may be missed on initial chest roentgenograms.

Purpose of the Study:

  • To evaluate the clinical significance and management of occult pneumothoraces detected on abdominal CT scans in patients with multisystem injuries.
  • To determine the relationship between pneumothorax size and the need for intervention.

Main Methods:

  • Retrospective review of 457 patients with multisystem injuries who underwent abdominal CT scans.
  • Quantification of 31 identified pneumothoraces by maximal width and CT section involvement.
  • Correlation of pneumothorax size with clinical management, including tube thoracostomy and positive pressure ventilation.

Main Results:

  • 26 patients had 31 occult pneumothoraces not visible on prior chest X-rays.
  • Pneumothoraces <5 X 80 mm (Group 1) required tube thoracostomy in 17% of cases.
  • Pneumothoraces >=5 X 80 mm (Group 2) required tube thoracostomy in 85% of cases.
  • Positive pressure ventilation was used in 55% of Group 1 and 77% of Group 2 pneumothoraces.

Conclusions:

  • Occult pneumothoraces <5 X 80 mm can be managed with close observation, even with positive pressure ventilation.
  • Larger pneumothoraces or those with associated rib fractures may necessitate early intervention.
  • Abdominal CT findings of pneumothorax require careful size assessment for appropriate management decisions.

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