Occult pneumothorax, revisited

Omar, Hesham R.; Abdelmalak, Hany; Mangar, Devanand; Rashad, Rania; Helal, Engy; Camporesi, Enrico M.
January 2010
Journal of Trauma Management & Outcomes;2010, Vol. 4, p12
Academic Journal
Pneumothorax is a recognized cause of preventable death following chest wall trauma where a simple intervention can be life saving. In cases of trauma patients where cervical spine immobilization is mandatory, supine AP chest radiograph is the most practical initial study. It is however not as sensitive as CT chest for early detection of a pneumothorax. "Occult" pneumothorax is an accepted definition of an existing but usually a clinically and radiologically silent disturbance that in most patients can be tolerated while other more urgent trauma needs are attended to. However, in certain patients, especially those on mechanical ventilation (with subsequent increase of intrapleural air with positive pressure ventilation), missing the diagnosis of pneumothorax can be deleterious with fatal consequences. This review will discuss the occult pneumothorax in the context of 3 radiological examples, which will further emphasize the entity. Because a negative AP chest radiograph can dangerously delay its recognition, we recommend that any trauma victim presenting to the emergency department with symptoms of respiratory distress should be screened with either thoracic ultrasonography or chest CT scan to avoid missing a pneumothorax.


Related Articles

  • Trauma management incorporating focused assessment with computed tomography in trauma (FACTT) - potential effect on survival. Kanz, Karl-Georg; Paul, April O.; Lefering, Rolf; Kay, Mike V.; Kreimeier, Uwe; Linsenmaier, Ulrich; Mutschler, Wolf; Huber-Wagner, Stefan // Journal of Trauma Management & Outcomes;2010, Vol. 4, p4 

    Background: Immediate recognition of life-threatening conditions and injuries is the key to trauma management. To date, the impact of focused assessment with computed tomography in trauma (FACTT) has not been formally assessed. We aimed to find out whether the concept of using FACTT during...

  • Traumatic cardiac arrest in the emergency department-overview upon primary causes. Georgescu, V.; Tudorache, O.; Strambu, V. // Journal of Medicine & Life;Apr-Jun2014, Vol. 7 Issue 2, p287 

    Rationale: Trauma is the leading cause of death for patients aged less than 40 years. Trauma patients with cardiac arrest have low survival rates, the resuscitation being often considered futile and consumptive of medical and human resources. Objective: The aim of this study Is to describe the...

  • Unwitnessed magnet ingestion in a 5 year-old boy leading to bowel perforation after magnetic resonance imaging: case report of a rare but potentially detrimental complication. Bailey, James R.; Eisner, Eric A.; Edmonds, Eric W. // Patient Safety in Surgery;2012, Vol. 6 Issue 1, p16 

    Background: The ingestion of non-food items in children is a relatively common event, often unwitnessed, unknown, and unreported. For those children brought in for medical evaluation, less than 10% require intervention, and only 1% require surgery. This, however, is not the case for magnet...

  • Treatment provider is most predictive of ED dismissal in minimally-injured trauma patients: a retrospective review. Hunt, Diane L. S.; Berg, Gina M.; Zackula, Rosalee E.; Ekengren, Francie H.; Lippoldt, Diana; Ablah, Elizabeth; Wetta, Ruth // Journal of Trauma Management & Outcomes;2013, Vol. 7 Issue 1, p1 

    Background: Secondary triage protocols have been described in the literature as physiologic (first-tier) criteria and mechanism-related (second-tier) criteria to determine the level of trauma activation. There is debate as to the efficiency of triage decisions based on mechanism of injury which...

  • Giant Choledochal Cyst Mimicking Massive Gallbladder Hydrops in an Adult Patient: Multi Detector Computed Tomography and Magnetic Resonance Imaging Findings Correlated to Gross and Histopathological Findings. Choi, Joon-Il; Lall, Chandana; Bhargava, Puneet; Imagawa, David K. // Journal of Clinical Imaging Science;Jan-Mar2013, Vol. 3 Issue 1, p1 

    Choledochal cysts are uncommon congenital anomalies of the biliary tree, commonly presenting in infancy, generally in the 1st year of life. Presentation in adult life is less common, accounting for 20% of cases. A 19-year-old female patient presented to the Emergency Department with severe...

  • Hyperdense appendix on unenhanced CT: a sign of acute appendicitis. Suk-Ping Ng; She-Meng Cheng; Fei-Shih Yang; Chi-Yuan Tzen; Jon-Kway Huang; Ng, Suk-Ping; Cheng, She-Meng; Yang, Fei-Shih; Tzen, Chi-Yuan; Huang, Jon-Kway // Abdominal Imaging;Nov2007, Vol. 32 Issue 6, p701 

    The purpose of this study was to evaluate the presence of the hyperdense appendix in acute appendicitis. The CT scans of 183 patients with pathologically proven acute appendicitis were reviewed to determine the prevalence of a hyperdense appendix, defined as a high-attenuated appendix when...

  • Early predictors of unfavourable outcome in subjects with moderate head injury in the emergency department. Fabbri, A.; Servadei, F.; Marchesini, G.; Stein, S. C.; Vandelli, A. // Journal of Neurology, Neurosurgery & Psychiatry;May2008, Vol. 79 Issue 5, p567 

    Background: Subjects with moderate head injury are a particular challenge for the emergency physician. They represent a heterogeneous population of subjects with large variability in injury severity, clinical course and outcome. We aimed to determine the early predictors of outcome of subjects...

  • Non-invasive ventilation: a nurse-led service. McBrien, Barry; Wynne, Cherry; Reilly, Rosaleen // Emergency Nurse;Oct2009, Vol. 17 Issue 6, p30 

    Respiratory diseases are the third most common presentations to emergency departments (EDs) in the Republic of Ireland. Evidence suggests that early non-invasive ventilation (NIV) is often the treatment of choice, particularly for patients with chronic obstructive pulmonary disease. Therefore,...

  • Identifying Children with Pneumonia in the Emergency Department. Mahabee-Gittens, E. Melinda; Jacqueline Grupp-Phelan; Alan S. Brody; Lane F. Donnelly; Bracey, Sheryl E. Allen; Duma, Elena M.; Mallory, Mia L.; Slap, Gall B. // Clinical Pediatrics;Jun2005, Vol. 44 Issue 5, p427 

    Emergency physicians need to clinically differentiate children with and without radiographic evidence of pneumonia. In this prospective cohort study of 510 patients 2 to 59 months of age presenting with symptoms of lower respiratory tract infection, 100% were evaluated with chest radiography and...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics