Pneumothorax is a recognized cause of preventable death following chest wall trauma where a simple intervention can be life saving. In cases of trauma patients where cervical spine immobilization is mandatory, supine AP chest radiograph is the most practical initial study. It is however not as sensitive as CT chest for early detection of a pneumothorax. "Occult" pneumothorax is an accepted definition of an existing but usually a clinically and radiologically silent disturbance that in most patients can be tolerated while other more urgent trauma needs are attended to. However, in certain patients, especially those on mechanical ventilation (with subsequent increase of intrapleural air with positive pressure ventilation), missing the diagnosis of pneumothorax can be deleterious with fatal consequences. This review will discuss the occult pneumothorax in the context of 3 radiological examples, which will further emphasize the entity. Because a negative AP chest radiograph can dangerously delay its recognition, we recommend that any trauma victim presenting to the emergency department with symptoms of respiratory distress should be screened with either thoracic ultrasonography or chest CT scan to avoid missing a pneumothorax.
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| http://dx.doi.org/10.1186/1752-2897-4-12 | DOI Listing |
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Article Synopsis
- This study examined the occurrence of occult pneumothorax (OP) in trauma patients and evaluated the effectiveness of chest X-rays (CXR) compared to chest CT scans in diagnosing these injuries.
- It included 1,284 patients at a trauma center, highlighting that supine CXR had low accuracy (46.7%) and sensitivity (12.7%) for diagnosing pneumothorax.
- Significant risk factors for OP identified were lung contusion and subcutaneous emphysema visible on CXR, suggesting that these indicators may warrant further imaging like CT if a chest CXR is inconclusive.
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