0:01

A few closing thoughts around pneumothorax.

0:04

So, spontaneous pneumothoraces are much more

0:07

common, 4.2 out of 100,000 people per year.

0:12

It occurs in all populations, but it's more common in older males.

0:17

Symptoms for pneumothorax, and again,

0:19

you may not get the full breadth of information in the requisition.

0:23

That's just kind of the nature of being a radiologist.

0:26

But symptoms include shortness of breath,

0:28

sharp stabbing, chest pain, tachypnea, tachycardia, dry cough.

0:33

Risk factors, smoking, age, COPD, height, male sex,

0:38

connective tissue disorders, prior pneumothorax,

0:41

or even prior instrumentation iatrogenic, sorts of causes.

0:45

So patients who may have had lung biopsies

0:48

could certainly have, as a risk factor, known risk factor, pneumothorax.

0:53

In terms of the imaging findings, again, an erect PA

0:56

is recommended because of the way air is going to layer.

1:01

However, these are patients who are

1:02

oftentimes sick and portable x-rays may be what you get.

1:07

So understand that a supine x-ray looking at a pneumothorax,

1:11

and appreciating pneumothorax is going to be very difficult

1:13

because the air is going to rise to the anterior portion of the chest

1:16

and that may be hard to see on the portable.

1:20

Chest CT is much more sensitive for detecting

1:22

pneumothorax, and if there's a high clinical suspicion but the pneumothorax is

1:27

not seen on the x-ray, consider recommending the CT.

1:30

You don't necessarily need to give IV contrast.

1:33

Ultrasound is an emerging tool used to

1:37

diagnose pneumothorax, and a lot of times

1:38

this is being done in the ED by ED providers.

1:41

It tends to be much more sensitive in neonates than in adults,

1:45

and it is still very much user-dependent. In terms of imaging findings,

1:50

you want to look for an area

1:51

of lucency near the edge of the lung.

1:54

You may see an absence of vessels that should extend beyond, or to the

1:58

edge that is no longer there.

2:00

You may see a shift of the mediastinum.

2:01

So we talked about evidence of tension and generally speaking,

2:05

when we have an air gap that's less than two, we're going to call that small,

2:08

greater than two, we're going to call that large.

2:11

In terms of pearls and pitfalls, we've

2:12

talked about supine and portable x-rays.

2:15

You might not appreciate gas in the pleural space because of the positioning, but

2:22

remember that you can also calculate

2:24

the pneumothorax based upon a couple of different

2:27

formulas and indices that are listed here,

2:29

and I'll provide references for them

2:31

I will say in my clinical practice,

2:33

I'll give an air gap, but most people have not asked me for an actual volume.

2:38

There are programs that will do that for you.

2:41

And here's a list of references.