title: Management of pneumothoraces detected on chest computed tomography: can anatomical location identify patients who can be managed expectantly?
abstract: BACKGROUND
  Pneumothorax (PTX) can be readily detected by computed tomography (CT) or ultrasound. However, management of PTX in hemodynamically stable patients remains controversial.
  
  
  OBJECTIVE
  We sought to investigate whether a distinct anatomical distribution of PTX along prespecified chest zones as detected by CT can be described in patients with or without subsequent chest tube thoracotomy (CTT), thus potentially allowing the extended focused assessment with sonography for trauma (EFAST) ultrasound examination to guide PTX management.
  
  
  METHODS
  We performed a retrospective review of chest CT scans performed in the emergency department (ED) of a Level I trauma center. CT scans were analyzed for PTX distribution according to a chest zone model. Medical records of subjects with PTX were reviewed for subsequent CTT.
  
  
  RESULTS
  Of 3636 chest CT scans performed, 183 PTX (156 patients) were detected without CTT at the time of CT scan (69% male, mean age 42 years). Of these, 66 subjects (40%) underwent CTT; 43 chest tubes (63%) were placed in the ED, 9 (13%) during hospitalization and 9 (13%) in the operating room. Median time to CTT was 140 min (interquartile range 52-199). Initial hemodynamic parameters, need for surgery, and need for mechanical ventilation were similar in both groups (p > 0.05 for all). Anatomical distribution and size of PTX were similar in the two groups.
  
  
  CONCLUSIONS
  Although the majority of patients with traumatic PTX could be managed conservatively, we did not identify a characteristic anatomical PTX pattern, which could identify subjects who may not require CTT.
authors: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Chioma
authors: C
authors: Agbo
authors: Department of Medicine II, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors: Dorothea
authors: D
authors: Hempel
authors: Department of Surgery, Tiefenauspital, Bern, Switzerland.
authors: Maria
authors: M
authors: Studer
authors: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Kavita
authors: K
authors: Gulati
authors: Department of Diagnostic Radiology, Yale-New Haven Hospital, New Haven, Connecticut.
authors: Isabel
authors: I
authors: Oliva
authors: Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
authors: Katja
authors: K
authors: Goldflam
authors: Department of Emergency Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Stephen
authors: S
authors: Ledbetter
authors: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Elke
authors: E
authors: Platz
mesh_terms: D000328:Adult; D015505:Chest Tubes; D004322:Drainage / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000628:therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D057832:Watchful Waiting; D055815:Young Adult
keywords: CT; anatomical distribution; pneumothorax; tube thoracostomy; ultrasound