Distribution of pneumothorax in the supine and semirecumbent critically ill adult

Tocino, Irene M.; Miller, Matt; Fairfax, Walter A.

doi:10.2214/ajr.144.5.901

Cited by 259 publications

(127 citation statements)

References 8 publications

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“…Also, anterior pneumothorax in neonates have atypical appearance which may be easily overlooked or misinterpreted as pneumomediastinum if not vigilant, especially when it is small in a supine neonate. It is essential to identify small pneumothorax to prevent its progression to tension pneumothorax [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Depending on the anatomy of the pleural recesses, the pneumothorax can be anteromedial, subpulmonic, apicolateral and posteromedial in location, with the first two being the most common [8,10,11]. The anteromedial space is the non-dependent pleural recess while supine; hence a small amount of air commonly accumulates in this space (as an anteromedial pneumothorax), which can later extend into the subpulmonic space and then the apicolateral space as more air is trapped [8][9][10]12].…”

Section: Discussionmentioning

confidence: 99%

“…The anteromedial space is the non-dependent pleural recess while supine; hence a small amount of air commonly accumulates in this space (as an anteromedial pneumothorax), which can later extend into the subpulmonic space and then the apicolateral space as more air is trapped [8][9][10]12]. …”

Section: Discussionmentioning

confidence: 99%

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Significance of small anteromedial or subpulmonic pneumothoraces on admission chest radiographs in late preterm/term neonates

Chan¹,

Jones²,

Jawahar³

et al. 2018

J Radiol Imaging.

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Purpose: To determine whether subtle anteromedial or subpulmonic pneumothorax (PTX) on neonatal admission chest radiograph is associated with depressed Apgar scores and significant resuscitation. Methods: Retrospective review of 375 neonates admitted to the Neonatal Intensive Care Unit from 2010-2014 with respiratory distress born at 34 -42 weeks gestation. All patients received anteriorposterior supine chest radiographs within 48 hours of birth. Records were reviewed for details on patient demographics, route of delivery, and Apgar scores at 1 and 5 min. Image interpretations were performed by radiologists and neonatologists blinded to patient clinical details and radiology reports. Significant resuscitative patterns were coded as early or late. Fisher's exact test and odds ratios were used to determine the significance. Results: 14/375 (4%) were reported positive for PTX by both radiologist and neonatologist groups. Among these 14, 11 (79%) had early resuscitation with positive pressure ventilation and/or continuous positive airway pressure within 5 min of birth, which was significant compared to the neonates without PTX (p = 0.026). The median one minute Apgar for neonates with PTX was lower (5.0) than those without PTX (8.0). No neonate with these chest radiograph findings developed a tension PTX. Conclusion: The presence of small anteromedial or subpulmonic PTX is associated with a difficult transition to extra-uterine life which is correlated with low Apgar scores at one minute. Reporting these PTX is important due to its relation to early resuscitation. These radiograph findings may warrant closer monitoring and a higher intensity of care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Significance of small anteromedial or subpulmonic pneumothoraces on admission chest radiographs in late preterm/term neonates

Chan¹,

Jones²,

Jawahar³

et al. 2018

J Radiol Imaging.

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“…In contrast to a pleural effusion, air rises to the non-dependent areas of the chest; in the supine position, air is found in anterior and medial locations. 44 Radiographic signs of a pneumothorax in the supine patient position are different from those found in the erect position. The radiographic signs include a hyperlucent anterior costophrenic sulcus, a hyperlucency over the upper abdominal quadrant, and an increased visualization of the contour of the diaphragm and the heart (Fig.…”

Section: Pneumothoraxmentioning

confidence: 98%

“…The incidence of pneumothorax in ventilated patients varies between 4% and 15%. 43,44 In the supine patient position, the classic findings of a pneumothorax are frequently lacking, and the pneumothorax is not diagnosed in up to 30%. 43 It is important to diagnose even a small pneumothorax, because, in ventilated patients, it may rapidly develop tension.…”

Section: Pneumothoraxmentioning

confidence: 99%

Bedside Chest Radiography

Eisenhuber¹,

Schaefer-Prokop

Prosch

et al. 2012

Respir Care

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Evaluation and Management of Patients with Chest Syndromes

Harrigan¹,

DeAngelis²

2007

Emergency Medicine: Avoiding the Pitfalls and Improving the Outcomes

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Table 1.1 Risk factors for painless acute MI [1]. Risk Factors % Without Chest Pain Prior heart failure 51 Prior stroke 47 Age Ͼ 75 years 45 Diabetes mellitus 38 Non-white 34 Women 39 1. QRS complex width Ͼ 0.12 s; 2. broad QS or rS pattern in the right precordial leads (leads V1, V2, and sometimes V3); KEY FACT | 7% of patients with acute MI or unstable angina had their pain partially or fully reproduced on chest wall palpation. KEY FACT | Sinus tachycardia was found in only 8-69% of patients (with PE). KEY FACT | The presence of pleurisy is neither sensitive nor specific for PE. In one study … pleuritic chest pain occurred in only 44% of patients with PE versus 30% of patients without PE.

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Distribution of pneumothorax in the supine and semirecumbent critically ill adult

Cited by 259 publications

References 8 publications

Significance of small anteromedial or subpulmonic pneumothoraces on admission chest radiographs in late preterm/term neonates

Significance of small anteromedial or subpulmonic pneumothoraces on admission chest radiographs in late preterm/term neonates

Bedside Chest Radiography

Evaluation and Management of Patients with Chest Syndromes

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