Occult Pneumothorax on Chest X-ray

Amrein, Karin; Sourij, Harald; Mader, Julia K.; Amrein, Steven; Robl, T.

doi:10.1016/j.ajem.2010.07.025

Cited by 2 publications

(5 citation statements)

References 2 publications

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“…Occult pneumothoraces are relatively common in trauma patients, with a rate of pneumothoraces that are found to be occult reported as between 29 and 79%. 2,3,4,[7][8][9][10] Wall and colleagues looked at abdominal CT in identifying pneumothoraces. They reported that 10 (29%) of 35 pneumothoraces detected by abdominal CT were occult whereas the rate of occult pneumothoraces was as high as 79% when Ball et al 4 looked at a subset of patients with penetrating chest wounds that were initially found to have a normal supine CXR and a CT confirmed pneumothorax.…”

Section: Incidencementioning

confidence: 99%

“…Various case reports have found much more unusual presentations, therefore there must always be a high index of suspicion within any trauma patient -whether due to blunt or penetrating trauma. 10,24 Despite the wave of research into appropriate supine CXR use, this first-line investigation has several issues. Although, there are multiple signs, several studies have shown that these are often missed.…”

Section: Associated Injuriesmentioning

confidence: 99%

“…31 In patients with subcutaneous emphysema, there is a false view of pleural motion and vertical artefacts similar to B lines 37 which may interfere with pneumothorax diagnosis, as may obesity, pleural adhesions or thoracic skin defects. 10 The other alternative to thoracic CT is abdominal CT but the evidence is highly variable. Abdominal CT routinely includes the lower thorax 38 and has been found to diagnose all occult pneumothoraces in blunt trauma independently or by combination with supine AP CXR, with a sensitivity of 96.5% and specificity of 100%.…”

Section: Alternatives To Thoracic Ctmentioning

confidence: 99%

“…Various case reports have found much more unusual presentations, therefore there must always be a high index of suspicion within any trauma patient – whether due to blunt or penetrating trauma. 10,24…”

Section: Associated Injuriesmentioning

confidence: 99%

Section: Alternatives To Thoracic Ctmentioning

confidence: 99%

See 4 more Smart Citations

Occult pneumothoraces – red flag or red herring?

Nassimizadeh

Taki

Nassimizadeh

et al. 2015

Trauma

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Pneumothorax is a relatively common complication following blunt chest trauma; however, the investigation and management of these injuries remains a contentious issue. Occult pneumothoraces are those not diagnosed by conventional radiographic imaging, but by subsequent computed tomography. This review examines the current evidence base behind the investigation and management of this condition. An anteroposterior chest x-ray should not be underestimated in its ability to provide sufficient radiological information to instigate an initial management plan in the trauma setting. Ultrasound has a high diagnostic rate for pneumothoraces; however, it is subjected to influence from other injuries, whilst failing to address other important injuries in trauma patients requiring computed tomography imaging. It is therefore best used in situations where computed tomography is unavailable or contraindicated. In the management of occult pneumothoraces, there is little difference in patient outcome between those managed conservatively or with a prophylactic chest drain. Clinicians must be wary of recommendations which in this area are often based on inadequate study size and they should continue to provide the best individual care on a case-by-case basis. Observation alone in patients that are haemodynamically stable can be considered, with a view to drainage of the pneumothorax should the clinical status of the patient deteriorate.

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