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: 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: Chest wall
  2. Posteroanterior (PA) Standard View - Inspiratory
    1. Best overall XRay to view to identify Pneumothorax
    2. Expiratory views were used in past to enhance Pneumothorax
      1. 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. High Test Sensitivity for Pneumothorax
  2. CT Chest
    1. Gold standard in Pneumothorax
    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

Images: Related links to external sites (from Google)

Ontology: Pneumothorax (C0032326)

Definition (NCI) Abnormal presence of air in the pleural cavity resulting in the collapse of the lung.
Definition (NCI) A disorder characterized by abnormal presence of air in the pleural cavity resulting in the collapse of the lung.
Definition (MSH) An accumulation of air or gas in the pleural space, which may occur spontaneously or as a result of trauma or a pathological process, or be introduced deliberately ( = PNEUMOTHORAX, ARTIFICIAL). (Dorland, 27th ed)
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 155609008, 155612006, 196106000, 36118008
English Pneumothorax, pneumothorax disorder, PNEUMOTHORAX, Pneumothorax, NOS, Pneumothorax NOS, Pneumothorax, unspecified, pneumothorax, pneumothorax (diagnosis), Pneumothorax NOS (disorder), Pneumothorax [Disease/Finding], free air in the chest outside the lung, Pneumothorax (disorder)
French PNEUMOTHORAX, Pneumothorax SAI, Pneumothorax, Pneumothorax spontané
Portuguese PNEUMOTORAX, Pneumotórax NE, Pneumotórax
Spanish NEUMOTORAX, Neumotórax NEOM, Pneumothorax, Pneumothorax NOS, neumotórax (trastorno), neumotórax, SAI (trastorno), neumotórax, SAI, neumotórax, Neumotorax, 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
Finnish Ilmarinta
Russian PNEVMOTORAKS, ПНЕВМОТОРАКС
Korean 상세불명의 공기가슴증, 공기가슴증
Croatian PNEUMOTORAKS
Polish Odma opłucnowa
Hungarian Pneumothorax, Pneumothorax k.m.n.