CT detection of occult pneumothorax in multiple trauma patients.
Chest injuries are the cause of death in 25% of trauma fatalities, and a major contributing factor in an additional 50%. Pneumothorax, the second most common chest injury, may often be initially overlooked. Administration of anesthesia and mechanical ventilation may produce enlargement of a pneumothorax and clinical deterioration. We reviewed 90 trauma patients who had been admitted with a diagnosis of pneumothorax or who had developed pneumothoraces after hospital admission. In 35 cases (38.8%), initial supine chest x-ray study failed to detect a pneumothorax, and the diagnosis was made on CT scan of the chest or abdomen performed within 2 hours of admission. In 15 of these cases (42.8%), identification of the pneumothorax on CT scan resulted in alterations in management, including chest tube placement in 10 patients and intensified monitoring in 5 patients. Failure to identify pneumothoraces in trauma patients may lead to deterioration and significant complications in patients requiring anesthesia or mechanical ventilation. CT scan may facilitate identification in these cases.
Bridges
K G
KG
Department of Surgery, Frankford Hospital, Philadelphia, PA 19114.
Welch
G
G
Silver
M
M
Schinco
M A
MA
Esposito
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D010414:Pennsylvania / Q000453:epidemiology; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications; D013997:Time Factors; D014057:Tomography, X-Ray Computed