Related Experiment Video
Updated: Jun 19, 2026
05:50
International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
The occult pneumothorax: what have we learned?
Chad G Ball1, Andrew W Kirkpatrick, David V Feliciano
1Department of Surgery, Grady Memorial Hospital, Emory University, Atlanta, GA 30303, USA. ball.chad@gmail.com
Canadian Journal of Surgery. Journal Canadien De Chirurgie
|October 30, 2009
Summary
Supine chest X-rays miss many traumatic pneumothoraces. Thoracic ultrasonography is highly effective at detecting these occult pneumothoraces, potentially avoiding unnecessary chest tube complications.
Area of Science:
- Emergency Medicine
- Radiology
- Trauma Surgery
Background:
- Supine anteroposterior chest radiography is an insensitive diagnostic tool for posttraumatic pneumothoraces.
- Computed tomography (CT) frequently identifies pneumothoraces missed by chest radiography, termed occult pneumothoraces.
- Occult pneumothoraces are found in up to 15% of trauma patients undergoing CT.
Purpose of the Study:
- To evaluate the diagnostic performance of various imaging modalities for detecting posttraumatic pneumothoraces.
- To compare the management of overt versus occult pneumothoraces.
- To assess the utility of thoracic ultrasonography in diagnosing pneumothoraces.
Main Methods:
- Review of literature on posttraumatic pneumothoraces.
- Analysis of diagnostic accuracy of chest radiography, CT, and thoracic ultrasonography.
- Comparison of tube thoracostomy rates for overt and occult pneumothoraces.
- Evaluation of clinical predictors for occult pneumothoraces.
Main Results:
- Up to 76% of pneumothoraces can be occult to supine chest radiography.
- Thoracic ultrasonography detects 92%-100% of all pneumothoraces.
- Patients with occult pneumothoraces are more likely to undergo tube thoracostomy, even without subcutaneous emphysema.
Conclusions:
- Thoracic ultrasonography is a sensitive and accessible method for diagnosing pneumothoraces in trauma patients.
- The high rate of tube thoracostomy for occult pneumothoraces warrants further investigation into conservative management.
- Avoiding unnecessary chest tube placement can prevent significant complications.
Related Concept Videos
01:08Pneumothorax II: Pathophysiology
Pneumothorax means the presence of air in the pleural space — the thin potential gap between the visceral and parietal pleura. This condition disrupts the normal pressure balance that keeps the lungs inflated, leading to partial or complete collapse of the affected lung.Normal physiologyUnder normal conditions, the pleural space maintains a slightly negative intrapleural pressure, which keeps the lungs expanded against the chest wall. This negative pressure creates a delicate balance between...
01:27Pneumothorax-II
Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
Clinical Manifestations:
01:26Pneumothorax-I
A pneumothorax is a condition where air builds up in the space between the lung and the chest wall, causing the lung to collapse. This condition arises when air enters the space between the parietal and visceral pleura, disrupting the negative pressure essential for lung inflation. This can lead to a partial or complete collapse of the lung.
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
01:13Pleura of the Lungs
The lungs are nestled in a cavity, shielded by the pleura. The pleura, a form of serous membrane, wraps around each lung. This membrane arrangement consists of two layers: the visceral and parietal pleurae. The visceral pleura lines the surface of the lungIn contrast, the parietal pleura is the outer layer and contacts to the thoracic wall, the mediastinum, and the diaphragm. The hilum is the point of connection between the visceral and parietal layers. The space between the parietal and...
01:26Endoscopic Studies II: Thoracocentesis
Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:10Atelectasis II: Pathophysiology
Atelectasis develops when alveoli lose their air and collapse inward. Because lung tissue is naturally elastic, these air sacs shrink rather than remaining open. Collapsed alveoli are no longer ventilated, reducing their role in gas exchange. Blood flow may continue in these regions, creating a ventilation–perfusion mismatch. Clinical findings include decreased breath sounds, dullness to percussion, reduced chest expansion, and decreased tactile fremitus as sound transmission through collapsed...