Pneumothorax Imaging

Aka: Pneumothorax Imaging, Chest XRay in Pneumothorax

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II. Images

  1. Complete Pneumothorax
    1. lungPtxComplete_PA.jpg
  2. Reexpansion Pulmonary Edema following Chest Tube placement
    1. lungPtxCompleteReExpansionPulmonaryEdema.jpg

III. Imaging: Chest XRay

  1. Findings
    1. Medial
      1. Thin, line representing visceral pleura
    2. Interspace
      1. Radiolucent band without lung markings
      2. Air-fluid level may be present (assume Hemothorax in Trauma)
    3. Lateral
      1. Chest wall
  2. Posteroanterior (PA) Standard View - Inspiratory
    1. Best overall XRay to view to identify Pneumothorax
    2. Obtain upright image, as supine Chest XRay is unreliable and likely to yield a False Negative study
    3. End Expiratory views were used in past to enhance Pneumothorax
      1. Theoretically should enhance the Pneumothorax which is constant, by reducing the air in lung
      2. Not recommended, as they add little additional to that seen on inspiratory films
  3. Lateral decubitus view (affected side up)
    1. May identify a small Pneumothorax suspected but not seen on upright Chest XRay
  4. Criteria for large Pneumothorax
    1. British Thoracic Society
      1. Band or rim around lung margin of 2 cm or greater (50% pleural volume)
    2. American College Chest Physicians
      1. Apex to Cupola distance >3 cm (15-20% of pleural volume)
  5. Efficacy
    1. Test Sensitivity: 85% (compared with CT Chest)
  6. False Positives
    1. Pulmonary Bleb (COPD) - may require CT chest to distinguish
    2. Skin folds
    3. Scapula border

IV. Imaging: Advanced

  1. Ultrasound chest
    1. See Lung Ultrasound for Pneumothorax (Sliding Lung Sign)
    2. Test Sensitivity 94% and Test Specificity 100% for Pneumothorax
  2. CT Chest
    1. Gold standard in Pneumothorax
      1. Even large pneumothoraces on CT may be missed on Chest XRay
      2. Rodriguez (2019) Ann Emerg Med 73(1):58-65 +PMID:30287121 [PubMed]
    2. Indicated where Chest XRay cannot distinguish bleb in COPD from Pneumothorax
    3. In those with Secondary Spontaneous Pneumothorax due to blebs, contralateral blebs are seen in >50% of cases
      1. These contralateral blebs have a 25% chance of future secondary Pneumothorax
    4. May identify a clinically insignificant Pneumothorax that would resolve without treatment
    5. Identifies other associated thoracic Traumatic Injury
      1. See Nexus Chest CT Decision Rule in Blunt Trauma

V. References

  1. Noppen (2003) Respiration 70(4): 431-8 [PubMed]
  2. Majoewsky (2012) EM:RAPC3 2(2): 3-4
  3. Tranchell (2013) Crit Dec Emerg Med 27(7): 11-8

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Related Studies

Ontology: Pneumothorax (C0032326)

Definition (MSH) An accumulation of air or gas in the PLEURAL CAVITY, which may occur spontaneously or as a result of trauma or a pathological process. The gas may also be introduced deliberately during PNEUMOTHORAX, ARTIFICIAL.
Definition (MSHCZE) Přítomnost vzduchu v pleurální dutině, s následným smrštěním (kolapsem) plíce, zhoršením dýchání a nebezpečím hypoxie. Vzduch do pohrudniční dutiny proniká např. při úrazu (traumatický p., zevní p.) nebo při roztržení plíce poškozené onemocněním (prasknutí buly při emfyzému), někdy není příčina zřejmá. Pneumotorax bez zevní vyvolávající příčiny se označuje jako spontánní. Stav se projevuje dušností, bolestí na hrudi, suchým kašlem, v těžkých případech pak selháváním dechových funkcí a oběhu. Závažný je pneumotorax ventilový, kdy při každém nádechu vniká do hrudníku vzduch, který se „ventilově fungujícím“ otvorem nedostane ven; dochází k nárůstu tlaku a kompresi srdce a velkých cév (přetlakový pneumotorax). V některých případech se vzduch sám vstřebá, u jiných je nutný složitější zákrok (odsávání vzduchu, drenáž). Pneumotorax se někdy užíval i léčebně (arteficiální, terapeutický pneumotorax), klasicky při tuberkulóze. (cit. Velký lékařský slovník online, 2012 http://lekarske.slovniky.cz/ )
Definition (NCI_CTCAE) A disorder characterized by abnormal presence of air in the pleural cavity resulting in the collapse of the lung.
Definition (NCI) Abnormal presence of air in the pleural cavity.
Definition (NCI_CDISC) Abnormal presence of air in the pleural cavity.
Definition (CSP) accumulation of air or gas in the pleural space, which may occur spontaneously or as a result of trauma or a pathological process.
Concepts Disease or Syndrome (T047)
MSH D011030
ICD10 J93 , J93.9
SnomedCT 155612006, 155609008, 196106000, 36118008
LNC LA7466-1
English Pneumothorax, pneumothorax disorder, Pneumothorax NOS, Pneumothorax, unspecified, pneumothorax, pneumothorax (diagnosis), Pneumothorax [Disease/Finding], free air in the chest outside the lung, Pneumothorax NOS (disorder), Air in pleural space, PNEUMOTHORAX, Pneumothorax (disorder), Pneumothorax, NOS
French PNEUMOTHORAX, Pneumothorax SAI, Pneumothorax, Pneumothorax spontané
Portuguese PNEUMOTORAX, Pneumotórax NE, Pneumotórax
Spanish NEUMOTORAX, Neumotórax NEOM, neumotórax, SAI (trastorno), Pneumothorax NOS, neumotórax, SAI, neumotórax (trastorno), neumotórax, Neumotórax
German PNEUMOTHORAX, Pneumothorax NNB, Pneumothorax, nicht naeher bezeichnet, Pneumothorax
Dutch pneumothorax NAO, Pneumothorax, niet gespecificeerd, pneumothorax, Pneumothorax, Thorax, pneumo-
Italian Pneumotorace NAS, Pneumotorace
Japanese 気胸, 気胸ＮＯＳ, ｷｷｮｳNOS, ｷｷｮｳ
Swedish Luft i lungsäcken
Czech pneumotorax, Pneumotorax NOS, Pneumotorax, pneumothorax, PNO
Finnish Ilmarinta
Russian PNEVMOTORAKS, ПНЕВМОТОРАКС
Korean 상세불명의 공기가슴증, 공기가슴증
Croatian PNEUMOTORAKS
Polish Odma opłucnowa
Hungarian Pneumothorax, Pneumothorax k.m.n.
Norwegian Pneumothorax, Luft i lungesekken, Punktert lunge
Derived from the NIH UMLS (Unified Medical Language System)

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