From the Guidelines
A pneumothorax is typically diagnosed by a chest X-ray, which shows a dark space between the chest wall and the lung, with the absence of lung markings and a visible visceral pleural line, as recommended by the BTS guidelines for the management of spontaneous pneumothorax 1. When a pneumothorax is suspected, the initial diagnostic step is to perform a plain chest radiography, which is the standard method for diagnosing both primary and secondary spontaneous pneumothorax 1.
- Key diagnostic features on a chest X-ray include:
- Absence of lung markings in the dark area
- Presence of a visible visceral pleural line
- Increased radiolucency (blackness) in the affected side
- Collapsed lung appearing smaller and sometimes shifted away from the chest wall In cases where the clinical suspicion of pneumothorax is high but the PA radiograph is normal, a lateral chest or lateral decubitus radiograph should be performed 1.
- CT scanning is recommended in specific situations, such as differentiating a pneumothorax from complex bullous lung disease, suspected aberrant tube placement, or when the plain chest radiograph is obscured by surgical emphysema 1. The clinical history and physical examination are not reliable indicators of pneumothorax size, and arterial blood gas measurements are frequently abnormal in patients with pneumothorax 1.
- It is essential to recognize the radiographic signs of pneumothorax, as it can range from a minor condition to a life-threatening emergency requiring immediate intervention 1.
From the Research
Pneumothorax Classification
- Pneumothorax can be classified into primary and secondary, with primary occurring without an apparent cause and in the absence of significant lung disease, and secondary occurring in the presence of existing lung pathology 2
- Pneumothorax can also be classified as traumatic, iatrogenic, or spontaneous, with spontaneous further subdivided into primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) 3
Pneumothorax Diagnosis
- Diagnosis of pneumothorax typically includes chest X-ray or computed tomography (CT) scan 2
- Ultrasonography is emerging as a diagnostic procedure of choice for pneumothorax, especially in critically ill patients 4
- Physical examination findings, such as dyspnea, chest pain, tachypnea, and absent breath sounds on lung auscultation, can also indicate pneumothorax 5
Pneumothorax Treatment
- Small spontaneous pneumothoraces can resolve without treatment and require only monitoring 2
- Treatment for pneumothorax can include observation, manual aspiration, insertion of a small-bore catheter, or chest tube drainage, depending on the size and severity of the pneumothorax 6
- In critically ill patients, pneumothorax should be managed with tube thoracostomy, and immediate decompression and drainage should be performed if there is suspicion for tension pneumothorax 4
- Operative procedures, such as surgery, can have a clear protective effect from recurrence in spontaneous pneumothorax, and should be considered when treating hospitalized patients 3