American Journal of Roentgenology, Vol 171, 1317-1320, Copyright © 1998 by American Roentgen Ray Society

ARTICLES

Validity of CT classification on management of occult pneumothorax: a prospective study

NT Wolfman, WS Myers, SJ Glauser, JW Meredith and MY Chen
Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1088, USA.

OBJECTIVE: In the setting of blunt trauma, abdominal CT, which routinely includes images of the lower thorax, frequently reveals pneumothoraces that have not been detected on routine supine chest radiographs. Proper management of these occult pneumothoraces remains controversial. The purpose of this study was to test the hypothesis that small (minuscule) to moderate (anterior) radiographically occult pneumothoraces can be safely managed without chest tube placement for patients in whom the need for positive pressure ventilation is not anticipated. SUBJECTS AND METHODS: We undertook a prospective study in which 44 occult pneumothoraces were classified into three groups, minuscule, anterior, or anterolateral, according to size and location on CT scans. Choice of initial management (tube thoracostomy versus close observation) was based in part on this classification system and in part on individual circumstances of a surgeon's decision. RESULTS: Of the 44 pneumothoraces found in 36 patients, 16 pneumothoraces were minuscule, 20 were anterior, and eight were anterolateral. Thirteen minuscule pneumothoraces and 11 anterior pneumothoraces initially managed with observation did not require subsequent tube thoracostomy. All eight patients with anterolateral pneumothoraces underwent tube thoracostomy. CONCLUSION: Most small (minuscule) occult pneumothoraces can successfully be managed with close observation. The risk that the pneumothorax will progress is slight. Moderate-sized (anterior) pneumothoraces may also be successfully managed without initial placement of a chest tube if the patient is not to undergo positive pressure ventilation.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				O. R. Brook, N. Beck-Razi, S. Abadi, J. Filatov, A. Ilivitzki, D. Litmanovich, and D. Gaitini Sonographic Detection of Pneumothorax by Radiology Residents as Part of Extended Focused Assessment With Sonography for Trauma J. Ultrasound Med., June 1, 2009; 28(6): 749 - 755. [Abstract] [Full Text] [PDF]

				G. Soldati, A. Testa, S. Sher, G. Pignataro, M. La Sala, and N. G. Silveri Occult Traumatic Pneumothorax: Diagnostic Accuracy of Lung Ultrasonography in the Emergency Department Chest, January 1, 2008; 133(1): 204 - 211. [Abstract] [Full Text] [PDF]

				R. Jenner and A. Sen Best evidence topic report. Chest drains in traumatic occult pneumothorax. Emerg. Med. J., February 1, 2006; 23(2): 138 - 139. [Full Text] [PDF]

				F. Tacconi, E. Pompeo, and T. C. Mineo Late-Onset Occult Pneumothorax After Lung Volume-Reduction Surgery Ann. Thorac. Surg., December 1, 2005; 80(6): 2008 - 2012. [Abstract] [Full Text] [PDF]

				P Gilligan, D Hegarty, and T B Hassan The point of the needle. Occult pneumothorax: a review Emerg. Med. J., May 1, 2003; 20(3): 293 - 296. [Abstract] [Full Text] [PDF]

				G. Little, M. Kelly, and E Glucksman Critical pitfalls in the immediate assessment of the trauma patient Trauma, January 1, 2001; 3(1): 43 - 51. [Abstract] [PDF]