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Occult pneumothorax, revisited.

Omar HR, Abdelmalak H, Mangar D, Rashad R, Helal E, Camporesi EM - J Trauma Manag Outcomes (2010)

Bottom Line: Pneumothorax is a recognized cause of preventable death following chest wall trauma where a simple intervention can be life saving.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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departement of Internal Medicine, Mercy Hospital and Medical Center, Chicago, Illinois, USA. hesham_omar2003@yahoo.com.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus

AP chest X-ray revealing no evidence of pneumothorax (Panel A). CT chest performed immediately after X-ray revealed right sided pneumothorax (Panel B).
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Figure 1: AP chest X-ray revealing no evidence of pneumothorax (Panel A). CT chest performed immediately after X-ray revealed right sided pneumothorax (Panel B).

Mentions: Due to the increased utilization of CT chest and thoracic ultrasonography as the initial screening tests for thoracic and abdominal trauma, occult pneumothorax has been common. Most nonradiologists diagnose pneumothorax based on the visualization of a superior-lateral visceral pleural stripe on the upright chest radiograph. This is however not feasible in the supine chest radiograph unless there is a sizable pneumothorax. Unfortunately, because of clinical concerns in trauma patients regarding cervical spine immobilization, initial imaging in seriously injured patients typically consists of a supine AP chest X-ray that is insensitive for detecting pneumothorax. As illustrated in figure 1 after an initial AP chest radiograph failed to show evidence of pneumothorax, a CT chest performed immediately after the chest Xray revealed right-sided pneumothorax.


Occult pneumothorax, revisited.

Omar HR, Abdelmalak H, Mangar D, Rashad R, Helal E, Camporesi EM - J Trauma Manag Outcomes (2010)

AP chest X-ray revealing no evidence of pneumothorax (Panel A). CT chest performed immediately after X-ray revealed right sided pneumothorax (Panel B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2984474&req=5

Figure 1: AP chest X-ray revealing no evidence of pneumothorax (Panel A). CT chest performed immediately after X-ray revealed right sided pneumothorax (Panel B).
Mentions: Due to the increased utilization of CT chest and thoracic ultrasonography as the initial screening tests for thoracic and abdominal trauma, occult pneumothorax has been common. Most nonradiologists diagnose pneumothorax based on the visualization of a superior-lateral visceral pleural stripe on the upright chest radiograph. This is however not feasible in the supine chest radiograph unless there is a sizable pneumothorax. Unfortunately, because of clinical concerns in trauma patients regarding cervical spine immobilization, initial imaging in seriously injured patients typically consists of a supine AP chest X-ray that is insensitive for detecting pneumothorax. As illustrated in figure 1 after an initial AP chest radiograph failed to show evidence of pneumothorax, a CT chest performed immediately after the chest Xray revealed right-sided pneumothorax.

Bottom Line: Pneumothorax is a recognized cause of preventable death following chest wall trauma where a simple intervention can be life saving.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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departement of Internal Medicine, Mercy Hospital and Medical Center, Chicago, Illinois, USA. hesham_omar2003@yahoo.com.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus