Materiały źródłowe

• #1 Pneumothorax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441885/

  A pneumothorax is a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleura inside the chest. The air accumulation can apply pressure on the lung and make it collapse. Pneumothoraces can be even further classified as simple, tension, or open. This activity examines when this condition should be considered in differential diagnosis and how to evaluate it properly. […] A pneumothorax is a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleurae inside the chest. The air accumulation can apply pressure on the lung and make it collapse. […] Pneumothorax enlarges, and the lung gets smaller due to this vital capacity, and oxygen partial pressure decreases. Clinical presentation of a pneumothorax can range anywhere from asymptomatic to chest pain and shortness of breath. A tension pneumothorax can cause severe hypotension (obstructive shock) and even death.

• #1 Clinical presentation and diagnosis of pneumothorax – UpToDate

  https://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-pneumothorax

  Clinical presentation and diagnosis of pneumothorax […] Gas in the pleural space is termed a pneumothorax. Appropriate treatment of pneumothorax is dictated by the clinical assessment of symptoms, size, and etiology. Thus, prompt recognition and therapy directed at the pneumothorax and its etiology are important to prevent further deterioration. […] In this topic review, the clinical presentation and diagnosis of pneumothorax are discussed. […] Pneumothorax should be suspected in patients who present with acute dyspnea and chest pain (classically pleuritic), particularly in those with an underlying risk factor (table 1). The major competing diagnoses include acute pulmonary embolism, pleuritis, pneumonia, myocardial ischemia or infarction, pericarditis, and musculoskeletal pain. Routine laboratories, electrocardiography, and chest imaging are usually performed during the diagnostic evaluation process; it is the identification of a pneumothorax on chest imaging that typically differentiates pneumothorax from many of these entities. […] Clinical manifestations — Patients with pneumothorax classically present with the following: […] History – Pneumothorax most often presents with sudden onset of dyspnea and pleuritic chest pain. Since pneumothorax is usually unilateral, the pain is usually felt on the ipsilateral side, but may be central or bilateral in rare cases where pneumothorax is bilateral.

• #1 Pneumothorax – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/504

  A pneumothorax is an accumulation of air in the pleural space. […] A secondary spontaneous pneumothorax occurs in relation to a known lung disease. […] A tension pneumothorax, when intrapleural pressure exceeds atmospheric pressure throughout expiration, is a medical emergency that requires immediate intervention to decompress (needle or open) the involved hemithorax. […] Patients with pneumothoraces typically complain of dyspnea and chest pain. […] Key diagnostic factors include chest pain, dyspnea, hyperexpanded ipsilateral hemithorax, hyper-resonant ipsilateral hemithorax, ipsilateral absent or diminished breath sounds, extreme breathlessness, and trachea shifted to contralateral side. […] 1st tests to order include chest x-ray and chest ultrasound. […] Tests to consider include CT chest and bronchoscopy.

• #1 Pneumothorax | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pneumothorax?lang=us

  Pneumothorax (PTX) refers to the presence of gas in the pleural space which allows the parietal and visceral pleura to separate and the lung to collapse. The clinical consequences range from negligible to hemodynamic collapse and death. […] Presentation is variable and may range from no symptoms to severe dyspnea with tachycardia and hypotension. In patients with a tension pneumothorax, presentation may include distended neck veins and tracheal deviation, cardiac arrest, and death in the most severe cases. […] A pneumothorax is, when looked for, usually easily appreciated on erect chest radiographs. Typically they demonstrate: visible visceral pleural edge is seen as a very thin, sharp white line; no lung markings are seen peripheral to this line; peripheral space is radiolucent compared to the adjacent lung; lung may completely collapse; mediastinum should not shift away from the pneumothorax unless a tension pneumothorax is present. […] Provided lung windows are examined, a pneumothorax is very easily identified on CT, and should pose essentially no diagnostic difficulty.

• #1 Symptoms, Diagnosis and Treating Pneumothorax | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumothorax/symptoms-diagnosis-treatment

  How Pneumothorax is Diagnosed: During an initial physical exam, your doctor will want to specifically listen to your chest through a stethoscope. As you breathe, they may tap your chest and listen for hollow sounds. Since higher than normal levels of carbon dioxide and low levels of oxygen can be indicators, your doctor may suggest an arterial blood gas test to test these levels. To get a definite diagnosis, your doctor will most likely need to order an imaging test such as a chest X-ray, an ultrasound or CT scan.

• #1 Diagnosis and Management of Spontaneous Pneumothorax | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0915/p1398.html

  Spontaneous pneumothorax occurs in persons who do not have clinically apparent lung disease. […] Patients with spontaneous pneumothorax do not have clinically apparent lung disease. However, studies have found that 76 to 100 percent have subpleural bullae diagnosed by video-assisted thoracoscopic surgery. […] The physical examination may be normal in patients with a small pneumothorax (less than 15 percent of the hemithorax). Tachycardia is the most common finding and, depending on the amount of lung involved, other physical findings include decreased chest wall movement, a hyperresonant percussion note, diminished fremitus and diminished or decreased breath sounds. […] The initial treatment of spontaneous pneumothorax involves removing air from the subpleural space. […] Surgical intervention is rarely necessary in patients with primary pneumothorax and does not become a consideration unless the air leak persists for four to seven days. […] The decision to use sclerosing agents such as talc to prevent recurrence must be individualized.

• #1 Pneumothorax – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pneumothorax/diagnosis-treatment/drc-20350372

  A pneumothorax is generally diagnosed using a chest X-ray. In some cases, a computerized tomography (CT) scan may be needed to provide more-detailed images. Ultrasound imaging also may be used to identify a pneumothorax. […] If a larger area of your lung has collapsed, it’s likely that a needle or chest tube will be used to remove the excess air. […] Sometimes surgery may be necessary to close the air leak. In most cases, the surgery can be performed through small incisions, using a tiny fiber-optic camera and narrow, long-handled surgical tools. The surgeon will look for the leaking area or ruptured air blister and close it off.

• #1 Pneumothorax – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pneumothorax/

  The diagnosis of pneumothorax is usually confirmed by chest x-ray. […] Ultrasound is becoming an increasingly accepted modality for identifying pneumothorax and is part of the eFAST. […] CT can provide information about the underlying cause (e.g., bullae in spontaneous pneumothorax). […] Tension pneumothorax is primarily a clinical diagnosis and prolonged diagnostic studies should be avoided in favor of initiating immediate treatment. […] In cases of tension pneumothorax, immediate decompression is a priority and should not be delayed by imaging. […] Indications: all patients suspected of having pneumothorax. […] Procedure: Upright PA chest x-ray in inspiration is the modality of choice. […] Supportive findings of pneumothorax include ipsilateral pleural line with reduced/absent lung markings (i.e., increased transparency).

• #1 Pneumothorax – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441885/

  Chest radiography, ultrasonography, or CT can be used for diagnosis, although diagnosis from a chest x-ray is more common. […] If a patient is hemodynamically unstable with suspected tension pneumothorax, intervention is not withheld to await imaging. Needle decompression can be performed if the patient is hemodynamically unstable with a convincing history and physical exam, indicating tension pneumothorax. […] Management depends on the clinical scenario. For patients with associated symptoms and showing signs of instability, needle decompression is the treatment of a pneumothorax. […] Pneumothorax on chest radiography approximately 25% or larger usually needs treatment with needle aspiration if symptomatic, and if it fails, then tube thoracostomy is done. […] Do not let a chest radiograph or CT scan delay treatment with needle decompression or thoracostomy tube if the patient is clinically unstable, i.e., tension pneumothorax.

• #1 Diagnóstico del Neumotórax | PortalCLÍNIC

  https://www.clinicbarcelona.org/en/assistance/diseases/pneumothorax/diagnosis

  The clinical manifestations of pneumothorax are usually a certain degree of tachycardia together with a decrease in the motility of the affected hemithorax, reduction or absence of respiratory noise, increased resonance to percussion and decreased voice transmission, sometimes with subcutaneous emphysema. […] Thorax radiography is diagnostic and identifies the presence of air in the pleural cavity which, to a greater or lesser extent, causes the collapsed lung. […] Computed tomography (CT) is not routinely recommended for a patient with a first episode of spontaneous pneumothorax and is limited to certain specific cases, such as detecting small pneumothorax, emphysema or bullous disease with a possible indication of surgery.

• #1 Diagnostics and Therapeutics: Managing Pneumothorax — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/pneumothorax

  There are many different types of pneumothorax (PTX), and the management paradigm has shifted in recent years as the research has exploded on this topic. […] This post aims to broadly cover the types of PTX, the diagnostic modalities available, and the ideal management by PTX type in the Emergency Department. […] There are a number of sizing guidelines that differ based on the country of origin and associated society. […] Ultimately, clinical presentation and symptoms are more important than size in determining management. […] Sensitivity 44-47%, Specificity 100%. […] Chest XR: Sensitivity 44-47%, Specificity 100%. […] Lung POCUS: Sensitivity 91-98.6%, Specificity 85.5-99%. […] CT Chest: Gold standard for detecting small pneumothoraces and size determination. […] Chest tubes are available in a range of sizes, the smallest of which are pigtail, or 14 French (Fr), and the largest of which are large-bore catheters up to 40Fr in diameter.

• #1

  https://link.springer.com/article/10.1007/s00134-010-2079-y

  Over the last decade, the use of ultrasound as a technique to look for pneumothorax has rapidly evolved. […] This review aims to analyze and synthesize current knowledge on lung ultrasound targeted at the diagnosis of pneumothorax. […] Ultrasound diagnosis of pneumothorax relies on the recognition of four sonographic artifact signs: the lung sliding, the B lines, the lung point, and the lung pulse. […] Sensitivity of a lung ultrasound in the detection of pneumothorax is higher than that of conventional anteriorposterior chest radiography, and similar to that of computerized tomography. […] A major benefit of a lung ultrasound is that it can be used quickly to diagnose pneumothorax at the bedside in any critical situation, like cardiac arrest and hemodynamically unstable patients. […] Advantages in terms of reduced complexity, feasibility at the bedside, and absence of exposure to ionizing radiation make lung ultrasound the method of choice in several common clinical situations.

• #1 Pneumothorax: Nursing Diagnoses, Care Plans, Assessment & Interventions | NurseTogether

  https://www.nursetogether.com/pneumothorax-nursing-diagnosis-care-plan/

  Pneumothorax or collapsed lung is caused by air leaking into the pleural cavity. […] Treatment often includes the insertion of a chest tube connected to suction monitored by the nurse. […] Chest radiography is used to diagnose a pneumothorax, evaluate the severity of the pneumothorax and potential causes, and provide a baseline to assess the effectiveness of the treatment plan. […] Plain radiographs may not detect thoracic damage, so computed tomography (CT) should be utilized for significant chest injuries. […] ABG analysis is vital for patients with respiratory distress or underlying lung disease to assess for hypoxemia, hypercarbia, and acidosis. […] Chest tubes are essential as they help drain air and fluid from the pleural space. […] A chest x-ray can confirm pneumothorax and the severity of the condition. […] Air can reabsorb into the pleural space and supplemental oxygen can increase reabsorption. […] If the lung remains unexpanded after 5 days with a chest tube, surgical options like thoracoscopy, electrocautery, resection of blebs or pleura, or open thoracotomy may be advised.

• #1 Pneumothorax – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pneumothorax/

  Supportive findings of tension pneumothorax include ipsilateral diaphragmatic flattening/inversion and widened intercostal spaces. […] Pneumothorax is very difficult to identify on supine CXR; consider ultrasound or CT chest in patients unable to sit upright. […] Indications for chest CT include uncertain diagnosis despite chest x-ray and complex cases. […] The size of a pneumothorax is assessed via imaging (e.g., CXR, CT chest). […] Laboratory analysis is generally not indicated. […] Arterial blood gas analysis (ABG) indications include SpO2 on room air and evaluation for CO2 retention in patients with lung disease. […] The treatment of unstable or high-risk traumatic pneumothorax (e.g., tension pneumothorax) is identical to the treatment of unstable spontaneous pneumothorax: emergency chest decompression. […] Tension pneumothorax is a clinical diagnosis and a medical emergency requiring immediate chest decompression.

• #1 Pneumothorax (Collapsed Lung): Symptoms and Treatment

  https://www.webmd.com/lung/what-is-a-collapsed-lung

  Your doctor will probably start with a physical exam. Theyll listen to your breathing through a stethoscope and tap your chest to find out if it sounds hollow. […] You might have tests including: X-rays, so your doctor can see the outline of your lung; A CT scan, a series of X-rays that a computer turns into a detailed image of your lung; Arterial blood gas or pulse oximetry, to measure how much oxygen is in your blood; EKG, to check how well your heart is working.

• #1 Diagnosis of pneumothorax | PPT

  https://www.slideshare.net/slideshow/diagnosis-of-pneumothorax/76409858

  A pneumothorax is usually diagnosed through a physical exam and chest x-ray, with additional tests that may include arterial blood gases, chest CT scan, and electrocardiogram. […] Abnormal results on x-rays, CT scans, or blood gases can confirm a pneumothorax diagnosis. […] A pneumothorax usually is diagnosed through a physical exam and a chest X-ray. Tests that may be ordered include: Arterial blood gases and other blood tests. Chest x-ray. CT scan if other injuries or conditions are suspected. Electrocardiogram. […] Diagnosis of Pneumothorax Chest x-ray: Abnormal result (Pneumothorax) Electrocardiogram (ECG): can help to evaluate for a cardiac cause of the patient’s symptoms. […] Diagnosis of Pneumothorax CT scan: Abnormal result (Pneumothorax) Air seen within the pleural space.

• #1 Coming up for Err: Missed Diagnosis in a Patient with Recurrent Pneumothorax | PSNet

  https://psnet.ahrq.gov/web-mm/coming-err-missed-diagnosis-patient-recurrent-pneumothorax

  The patients CT scan showed classic features of lymphangioleiomyomatosis (LAM), a rare cystic lung disease that is most often seen in young women. […] The diagnosis of LAM can be made based on these characteristic CT findings along with blood testing for VEGF-D3 (vascular endothelial growth factor D), which is specific for LAM if it is higher than 800pg/ml. […] It has been recommended that clinicians consider ordering a CT scan of the chest for patients presenting with an unexplained spontaneous pneumothorax. […] In this case, at the initial ED presentation, the CT scan would likely have demonstrated diffuse cystic lung disease, which in retrospect appears to have been misdiagnosed by the ED physician, radiologist, and first pulmonary consultant as mild emphysema with small cysts and blebs.

• #1 Pneumothorax Differential Diagnoses

  https://emedicine.medscape.com/article/424547-differential

  This section reviews some important points to consider in the diagnosis of pneumothoraces. […] The diagnosis of a tension pneumothorax should largely be based on the history and physical examination findings. Ultrasonography (US) in the emergency setting is increasingly being used as an adjunct to the physical examination when there is doubt regarding the diagnosis. Chest radiography or CT should be used only in those instances when the diagnosis is in doubt and when the patient is hemodynamically stable. Obtaining such imaging studies when the diagnosis of tension pneumothorax is not in question causes an unnecessary and potentially lethal delay in treatment. […] A high index of suspicion for tension pneumothorax is recommended in patients on mechanical ventilation with acute onset of hemodynamic instability, difficult ventilation with high inspiratory pressures, and worsening hypoxemia and/or hypercapnia, even with a functioning chest tube in place.

• #1 Pneumothorax – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pneumothorax/symptoms-causes/syc-20350367

  A pneumothorax (noo-moe-THOR-aks) is a collapsed lung. A pneumothorax occurs when air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse. A pneumothorax can be a complete lung collapse or a collapse of only a portion of the lung. […] Treatment for a pneumothorax usually involves inserting a needle or chest tube between the ribs to remove the excess air. However, a small pneumothorax may heal on its own. […] Symptoms of a pneumothorax can be caused by a variety of health problems, and some can be life-threatening, so seek medical attention. If your chest pain is severe or breathing becomes increasingly difficult, get immediate emergency care. […] A pneumothorax can be caused by: […] Any blunt or penetrating injury to your chest can cause lung collapse.

• #1 Pneumothorax (Traumatic) – Injuries; Poisoning – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/injuries-poisoning/thoracic-trauma/pneumothorax-traumatic

  Diagnosis is made by chest x-ray. […] Diagnosis is usually made by chest x-ray. Ultrasonography (done at the bedside during initial resuscitation, Extended Focused Assessment With Sonography in Trauma [E-FAST]) and CT are more sensitive for small pneumothoraces than chest x-ray. […] Although CT and ultrasonography are more sensitive, chest x-ray is usually considered sufficient for diagnosis.

• #1 Diagnostics and Therapeutics: Managing Pneumothorax — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/pneumothorax

  A 2010 systematic review of 3 RCTs found no difference in mortality, progression of PTX size, or length of hospital stay between chest tube and observation for stable trauma patients with occult PTX. […] Patients with O2 saturation 92% should be placed on supplemental O2. […] If they are stable and the patient is not significantly short of breath, it is reasonable to treat with supplemental O2 and observation alone. […] For stable patients, supplemental O2 and chest tube/catheter thoracostomy are generally preferred over conservative measures as the risk of aspiration failure, prolonged air leak, and progression to tension PTX are greater in those with underlying lung pathology. […] Large bore chest tubes were traditionally used in case of concomitant hemothorax for theoretically improved drainage and decreased clotting risk. […] Managed with emergent needle thoracostomy decompression or finger thoracostomy. […] In one study of blunt trauma patients found to have occult pneumothorax, 85% were managed conservatively and only 3.9% of those patients ultimately required chest tube placement.

• #1

  https://journals.lww.com/onlinejets/fulltext/2012/05010/sonographic_diagnosis_of_pneumothorax.17.aspx

  In addition, ultrasound is the perfect modality in the emergency and critical care setting after performing certain procedures, such as a thoracentesis or the placement of a central line, to quickly confirm the presence of lung-sliding and to rule out an iatrogenic pneumothorax. […] This article offers a review of the current evidence for the use of thoracic ultrasound in the diagnosis of a pneumothorax, reviews the proper techniques used, and highlights its clinical utility.

• #1 Factors for increasing positive predictive value of pneumothorax detection on chest radiographs using artificial intelligence | Scientific Reports

  https://www.nature.com/articles/s41598-024-70780-1

  This study evaluated the positive predictive value (PPV) of artificial intelligence (AI) in detecting pneumothorax on chest radiographs (CXRs) and its affecting factors. […] The overall PPV of AI about pneumothorax was 41.1% (TF:FP=136:195). […] Therefore, PPV for pneumothorax diagnosis using AI can vary based on patients factors, image-acquisition protocols, and the presence of concurrent lesions on CXR. […] Pneumothorax is a condition characterized by the abnormal collection of air in the pleural space, which requires urgent diagnosis and appropriate care. […] Chest radiographs (CXRs) are the primary diagnostic tool for pneumothorax. […] To mitigate the risk of missed diagnosis up to 20% of occult pneumothoraces artificial intelligence (AI)-based diagnostic tools or triage systems may offer a viable solution.

• #1 Factors for increasing positive predictive value of pneumothorax detection on chest radiographs using artificial intelligence | Scientific Reports

  https://www.nature.com/articles/s41598-024-70780-1

  Recent studies have shown that AI algorithms perform well in detecting pneumothorax, with reported areas under the receiver operating characteristics curve ranging from 0.91 to 0.97. […] While AI algorithms have the potential to reduce missed diagnosis of pneumothorax and decrease the turnaround time for CXR from critical patients, false-positive (FP) results remain a challenge. […] Hospitals that have implemented commercial AI-based diagnostic tools have reported that the benefits of AI vary depending on the clinical context and how FP results are managed. […] Therefore, the purpose of this study was to evaluate the actual positive predictive value (PPV) of an AI based tool for pneumothorax detection on CXR. […] The PPV was significantly different between PA and AP views (88.2% vs. 20.1%).

• #1 Factors for increasing positive predictive value of pneumothorax detection on chest radiographs using artificial intelligence | Scientific Reports

  https://www.nature.com/articles/s41598-024-70780-1

  Significant factors contributing to an increased PPV included younger patient age, the PA view of CXRs, a high abnormality score for pneumothorax, and a greater amount of pneumothorax. […] Additionally, the presence of concurrent atelectasis, small amounts of pleural effusion in the same lung, and the absence of consolidation, fibrosis, and nodules were significant factors that increased the PPV for pneumothorax. […] In conclusion, the overall PPV of the commercially available AI software for the diagnosis of pneumothorax was 41.1%, with different PPVs of 88.2% for the PA view and 20.1% for the AP view. […] The PPV for pneumothorax diagnosis using AI in CXR can vary based on patient factors, image-acquisition protocols, and the presence of concurrent lung lesions on CXR.

• #1 Digital tomography in the diagnosis of a posterior pneumothorax in the intensive care unit

  https://www.accjournal.org/journal/view.php?number=1369

  Portable chest radiography is a valuable tool in the intensive care unit. However, the supine position causes superposition of anatomical structures resulting in less reliable detection of certain abnormalities. […] Currently, computed tomography (CT)-scan is the gold standard for both the diagnosis and assessing the size of the pneumothorax. […] This technique may be able to improve the diagnostic value of bedside chest radiography due to its ability to distinguish overlapping anatomical structures. […] The combination of digital tomosynthesis technique with the already widely used portable X-ray machine could increase the diagnostic value of portable chest radiography in ICU as is presented in this case. […] CT scan is currently the gold standard for the diagnosis and assessing the size of a pneumothorax.

• #1 Digital tomography in the diagnosis of a posterior pneumothorax in the intensive care unit

  https://www.accjournal.org/journal/view.php?number=1369

  pDTS can be readily performed bedside, eliminating the risks associated with intrahospital transport of the patient, in turn also decreasing the risk of virus transmission in the current COVID-19 pandemic. […] pDTS is associated with a much lower radiation dose (0.54 mSv) than a chest CT scan (6.2 mSv). […] Although the technique seems promising, further research is needed. […] In order to do so, the comparison with CT scan, classic chest radiography and ultrasonography must be made in critically ill patients to assess the place of pDTS for the diagnosis of pneumothorax in the ICU setting.

• #1 Dual Energy X-ray for Pneumothorax Diagnosis

  https://kaimaging.com/dual-energy-x-ray-for-pneumothorax-diagnosis/

  With pneumothoraces potential for rapid clinical deterioration, timely recognition and intervention are crucial. […] Chest X-rays and CT scans are used to detect pneumothoraces. […] A chest X-ray can detect air in the pleural space and assess the degree of lung collapse. […] These challenges have resulted in frequent misdiagnosis of pneumothorax. […] An upright (standing) X-ray provides the best view for detecting small pneumothoraces. […] During its inception, dual energy X-ray technology held the potential to transform the diagnosis of pneumothorax. […] The soft tissue image acquired from the Reveal 35C is particularly useful for detecting pneumothorax. […] Pneumothorax is a serious medical condition that requires prompt and accurate diagnosis for effective treatment. Advances in radiology, particularly with the development of dual-energy X-ray technology like Reveal 35C, provide clinicians with enhanced imaging capabilities that improve the detection of pneumothorax.

• #1 Acute Pneumothorax Evaluation and Treatment | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27372

  Pneumothorax refers to the presence of air or gas within the pleural space—the space between the visceral and parietal pleura of the thoracic cavity. This accumulation can disrupt normal lung expansion, impairing ventilation and oxygenation. The clinical presentations of pneumothorax range from asymptomatic to a life-threatening emergency, depending on factors such as the volume of air, the rate of accumulation, and the patient’s underlying respiratory status. […] The diagnosis of pneumothorax is based on a combination of patient history, physical examination, laboratory tests, and imaging studies, with chest x-rays being the primary imaging modality. […] Spontaneous pneumothorax should always be considered when diagnosing patients with sudden-onset pleuritic chest pain and shortness of breath. Similarly, traumatic pneumothorax must be suspected in any case of blunt or penetrating chest trauma.

• #1 Pneumothorax – diagnosis and management in the ED – Pedmore Medical

  https://pedmore-medical.com/pneumothorax-diagnosis-and-management-in-the-ed/

  A pneumothorax, or collapsed lung, occurs when the space between the parietal and visceral pleura of the lung fill with air, causing pressure on the lung that leads to its collapse. […] A clinician in the Emergency Department would do well to maintain a high level of suspicion for this diagnosis in patients presenting with chest pain and shortness of breath. […] For a patient describing the sudden onset of these symptoms, without a history of recent trauma, a clinician should at least consider the diagnosis of spontaneous pneumothorax. […] A traumatic pneumothorax will exhibit very similar symptoms, however, the latter is more likely to occur shortly after a traumatic event or major medical intervention. […] While a diagnostic delay for either type can cause severe complications, a delay in diagnosing a tension pneumothorax is almost always deadly.

• #1 Acute Pneumothorax Evaluation and Treatment | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27372

  Misdiagnosis is a common complication of pneumothorax. Several factors can contribute, including an incomplete or inadequate history or physical examination, low clinical suspicion, failure to obtain a chest radiograph, or failure to recognize a pneumothorax on imaging. […] The management of pneumothorax often requires consultation with multiple specialists, depending on its severity and underlying cause.

• #1 Coming up for Err: Missed Diagnosis in a Patient with Recurrent Pneumothorax | PSNet

  https://psnet.ahrq.gov/web-mm/coming-err-missed-diagnosis-patient-recurrent-pneumothorax

  Given the low pre-test probability of emphysema in a young non-smoking woman, particularly if testing for alpha-1 antitrypsin deficiency was normal, a search for alternate diagnoses should have been undertaken in this case. […] A pneumothorax can occur in up to 70% of women with LAM. […] Because of the high rate of recurrence, a pneumothorax in a patient with LAM needs to be managed with pleurodesis, as finally occurred in this case. […] An important dictum in diagnostic safety is to reconsider the initial diagnosis (and in this case the underlying etiology) when a patient unexpectedly returns unimproved or with a recurrence. […] For patients with recurrent pneumothorax, aggressive management of the pneumothorax with additional imaging and referral to a lung specialty center is necessary to identify the cause and to consider additional treatments such as pleurodesis. […] Timely referral to a lung center where treatment can be initiated is important.

• #2 Pneumothorax – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/504

  A pneumothorax is an accumulation of air in the pleural space. […] A secondary spontaneous pneumothorax occurs in relation to a known lung disease. […] A tension pneumothorax, when intrapleural pressure exceeds atmospheric pressure throughout expiration, is a medical emergency that requires immediate intervention to decompress (needle or open) the involved hemithorax. […] Patients with pneumothoraces typically complain of dyspnea and chest pain. […] Key diagnostic factors include chest pain, dyspnea, hyperexpanded ipsilateral hemithorax, hyper-resonant ipsilateral hemithorax, ipsilateral absent or diminished breath sounds, extreme breathlessness, and trachea shifted to contralateral side. […] 1st tests to order include chest x-ray and chest ultrasound. […] Tests to consider include CT chest and bronchoscopy.

• #2 Clinical presentation and diagnosis of pneumothorax – UpToDate

  https://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-pneumothorax/print

  Clinical presentation and diagnosis of pneumothorax […] Appropriate treatment of pneumothorax is dictated by the clinical assessment of symptoms, size, and etiology. Thus, prompt recognition and therapy directed at the pneumothorax and its etiology are important to prevent further deterioration. […] In this topic review, the clinical presentation and diagnosis of pneumothorax are discussed. […] Pneumothorax should be suspected in patients who present with acute dyspnea and chest pain (classically pleuritic), particularly in those with an underlying risk factor. […] Routine laboratories, electrocardiography, and chest imaging are usually performed during the diagnostic evaluation process; it is the identification of a pneumothorax on chest imaging that typically differentiates pneumothorax from many of these entities. […] Clinical manifestations — Patients with pneumothorax classically present with the following: […] Pneumothorax most often presents with sudden onset of dyspnea and pleuritic chest pain.

• #2 Pneumothorax – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000083

  Pneumothorax occurs when air gains access to, and accumulates in, the pleural space. […] A tension pneumothorax is a medical emergency that requires immediate decompression. […] Patients with a pneumothorax typically report dyspnoea and chest pain. […] First-line treatment of pneumothoraces depends on the clinical scenario and patient preferences. […] Patients with spontaneous pneumothoraces are at risk for recurrence. […] Key diagnostic factors include chest pain, dyspnoea, ipsilateral reduced breath sounds, and hypoxia. […] 1st investigations to order include chest x-ray and blood tests. […] Investigations to consider include chest ultrasound and CT chest.

• #2 Tension pneumothorax | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/tension-pneumothorax?lang=us

  Tension pneumothoraces occur when progressive accumulation of intrapleural gas causes hemodynamic compromise. Urgent placement of a pleural drain can be life-saving and avert cardiorespiratory arrest. […] The diagnosis should be made from the clinical features and treatment should not be delayed. […] Urgent pleural drainage is life-saving and should not be delayed for radiographic confirmation. […] The diagnosis is a clinical one. Radiographic features do not measure actual intrapleural pressure or cardiorespiratory compromise.

• #2 Diagnóstico del Neumotórax | PortalCLÍNIC

  https://www.clinicbarcelona.org/en/assistance/diseases/pneumothorax/diagnosis

  The clinical manifestations of pneumothorax are usually a certain degree of tachycardia together with a decrease in the motility of the affected hemithorax, reduction or absence of respiratory noise, increased resonance to percussion and decreased voice transmission, sometimes with subcutaneous emphysema. […] Thorax radiography is diagnostic and identifies the presence of air in the pleural cavity which, to a greater or lesser extent, causes the collapsed lung. […] Computed tomography (CT) is not routinely recommended for a patient with a first episode of spontaneous pneumothorax and is limited to certain specific cases, such as detecting small pneumothorax, emphysema or bullous disease with a possible indication of surgery.

• #2 Pneumothorax: from definition to diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4203989/

  Pneumothorax is an urgent situation that has to be treated immediately upon diagnosis. […] Diagnosis of a pneumothorax requires a chest X-ray or computed tomography (CT) scan. […] The sudden onset of breathlessness in patients with known underlying lung diseases such as; COPD, cystic fibrosis, or other serious lung diseases should therefore prompt investigations to identify the possibility of a pneumothorax. […] The treatment of pneumothorax depends on a number of factors, and may vary from discharge with early follow-up to immediate needle decompression or insertion of a chest tube. […] Chest tube is typically inserted in an area under the axilla (armpit) called the safe triangle, where damage to internal organs can be avoided. […] Chest tubes are required in PSPs that have not responded to needle aspiration, in large SSPs (50%), and in cases of tension pneumothorax.

• #2 Pneumothorax – Lung and Airway Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/lung-and-airway-disorders/pleural-and-mediastinal-disorders/pneumothorax

  A pneumothorax is partial or complete collapse of the lung due to the presence of air between the two layers of pleura (thin, transparent, two-layered membrane that covers the lungs and also lines the inside of the chest wall). […] Diagnosis is by chest x-ray or ultrasonography. […] A physical examination can usually confirm the diagnosis if the pneumothorax is large. Using a stethoscope, a doctor may note that one part of the chest does not transmit the normal sounds of breathing and when the chest is tapped (percussed) the chest produces a hollow, drumlike sound. A chest x-ray shows the air pocket and the collapsed lung outlined by the thin inner pleural layer. A chest x-ray can also show if the trachea (the large airway that passes through the front of the neck) is being pushed to one side. Ultrasonography can also diagnose pneumothorax.

• #2 Pneumothorax – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pneumothorax/

  Supportive findings of tension pneumothorax include ipsilateral diaphragmatic flattening/inversion and widened intercostal spaces. […] Pneumothorax is very difficult to identify on supine CXR; consider ultrasound or CT chest in patients unable to sit upright. […] Indications for chest CT include uncertain diagnosis despite chest x-ray and complex cases. […] The size of a pneumothorax is assessed via imaging (e.g., CXR, CT chest). […] Laboratory analysis is generally not indicated. […] Arterial blood gas analysis (ABG) indications include SpO2 on room air and evaluation for CO2 retention in patients with lung disease. […] The treatment of unstable or high-risk traumatic pneumothorax (e.g., tension pneumothorax) is identical to the treatment of unstable spontaneous pneumothorax: emergency chest decompression. […] Tension pneumothorax is a clinical diagnosis and a medical emergency requiring immediate chest decompression.

• #2 Pneumothorax: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/424547-overview

  The following radiologic studies may be used to evaluate suspected pneumothorax: Chest radiography: Anteroposterior and/or lateral decubitus films; Contrast-enhanced esophagography: If emesis/retching is the precipitating event; Chest computed tomography scanning: Most reliable imaging study for diagnosis of pneumothorax but not recommended for routine use in pneumothorax; Chest ultrasonography.

• #2

  https://link.springer.com/article/10.1007/s00134-010-2079-y

  Over the last decade, the use of ultrasound as a technique to look for pneumothorax has rapidly evolved. […] This review aims to analyze and synthesize current knowledge on lung ultrasound targeted at the diagnosis of pneumothorax. […] Ultrasound diagnosis of pneumothorax relies on the recognition of four sonographic artifact signs: the lung sliding, the B lines, the lung point, and the lung pulse. […] Sensitivity of a lung ultrasound in the detection of pneumothorax is higher than that of conventional anteriorposterior chest radiography, and similar to that of computerized tomography. […] A major benefit of a lung ultrasound is that it can be used quickly to diagnose pneumothorax at the bedside in any critical situation, like cardiac arrest and hemodynamically unstable patients. […] Advantages in terms of reduced complexity, feasibility at the bedside, and absence of exposure to ionizing radiation make lung ultrasound the method of choice in several common clinical situations.

• #2 Diagnosing Pneumothorax | Emory School of Medicine

  https://med.emory.edu/departments/emergency-medicine/sections/ultrasound/case-of-the-month/lung/diagnosing_pneumothorax.html

  Place the linear probe on the chest oriented in the longitudinal direction with the probe marker pointing to the patients head. On ultrasound, ribs appear hyperechoic (bright) with shadowing posterior. Pleura is seen as a hyperechoic straight line extending between two rib shadows. Optimal screen depth allows for two ribs to flank the screen with pleura between. There is a shimmering motion noted at the pleural interface known as pleural sliding. Normal healthy lung without pleural injury will exhibit pleural sliding. […] Ultrasound is highly sensitive for detecting pneumothorax, much more so than chest plain film imaging. On ultrasound, pneumothorax is detected in B-mode by a lack of pleural sliding and on M-mode by a lack of motion artifact known as the bar code or stratosphere sign.

• #2

  https://journals.lww.com/onlinejets/fulltext/2012/05010/sonographic_diagnosis_of_pneumothorax.17.aspx

  The average time to perform this examination varies from two to three minutes; less than one minute to rule out a pneumothorax and several minutes to rule it in. […] In a pneumothorax, there is air present that separates the visceral and parietal pleura and prevents visualization of the visceral pleura. […] The negative predictive value for lung sliding is reported as 99.2100%, indicating that the presence of sliding effectively rules out a pneumothorax. […] The lung-point sign occurs at the border of a pneumothorax. […] The lung-point sign is 100% specific for pneumothorax and defines its border. […] Thoracic sonography for the detection of pneumothorax has become a well-established modality in the acute care setting. […] The traditional upright AP radiograph has become less important due to its poor sensitivity in diagnosing a pneumothorax compared to ultrasound.

• #2 Symptoms, Diagnosis and Treating Pneumothorax | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumothorax/symptoms-diagnosis-treatment

  How Pneumothorax is Diagnosed: During an initial physical exam, your doctor will want to specifically listen to your chest through a stethoscope. As you breathe, they may tap your chest and listen for hollow sounds. Since higher than normal levels of carbon dioxide and low levels of oxygen can be indicators, your doctor may suggest an arterial blood gas test to test these levels. To get a definite diagnosis, your doctor will most likely need to order an imaging test such as a chest X-ray, an ultrasound or CT scan.

• #2 Pneumothorax (Clollapsed Lung) Symptom, Causes, Treatments | Ada

  https://ada.com/conditions/pneumothorax/

  A doctor may suspect a pneumothorax if a person suddenly develops shortness of breath or chest pain, especially after trauma to the chest. They may ask about the affected persons medical history, including any previous or current smoking habits, and they may carry out a physical examination. Tests to confirm diagnosis may include: […] A chest X-ray (CXR) is often the best and quickest way to confirm the presence of a pneumothorax, which will appear on the X-ray as a darker area on the chest, representing the additional air in the chest cavity. […] In cases where there is doubt about the location or presence of a pneumothorax or for people with extensive lung disease, a CT scan may be used to find a small collapsed area of a lung. […] A doctor may also measure the oxygen level in the blood with a handheld device called a pulse oximeter, or they may draw blood from the wrist to directly measure the oxygen and carbon dioxide levels in the arterial blood, i.e. blood that has just passed through the lungs. While this alone does not normally allow for a diagnosis, it helps to determine how severely affected the person is and may help in determining treatment options.

• #2 Coming up for Err: Missed Diagnosis in a Patient with Recurrent Pneumothorax | PSNet

  https://psnet.ahrq.gov/web-mm/coming-err-missed-diagnosis-patient-recurrent-pneumothorax

  A 31-year-old woman with no past medical history presented to the Emergency Department (ED) with worsening shortness of breath. On examination and plain radiography, she was unexpectedly found to have a moderate-sized left pneumothorax. […] Three days later, the patient returned to the same ED with similar symptoms and again was found to have a left pneumothorax that required chest tube placement. […] After this second episode of spontaneous pneumothorax, she was discharged to her home after the chest tube was removed. […] The ED physician was concerned by the CT scan and requested another pulmonary consultation. This time, the on-call pulmonary physician diagnosed cystic lung disease based on the CT findings, and decided to transfer the patient to an advanced lung center for further immediate work-up and treatment.

• #2 Coming up for Err: Missed Diagnosis in a Patient with Recurrent Pneumothorax | PSNet

  https://psnet.ahrq.gov/web-mm/coming-err-missed-diagnosis-patient-recurrent-pneumothorax

  Given the low pre-test probability of emphysema in a young non-smoking woman, particularly if testing for alpha-1 antitrypsin deficiency was normal, a search for alternate diagnoses should have been undertaken in this case. […] A pneumothorax can occur in up to 70% of women with LAM. […] Because of the high rate of recurrence, a pneumothorax in a patient with LAM needs to be managed with pleurodesis, as finally occurred in this case. […] An important dictum in diagnostic safety is to reconsider the initial diagnosis (and in this case the underlying etiology) when a patient unexpectedly returns unimproved or with a recurrence. […] For patients with recurrent pneumothorax, aggressive management of the pneumothorax with additional imaging and referral to a lung specialty center is necessary to identify the cause and to consider additional treatments such as pleurodesis. […] Timely referral to a lung center where treatment can be initiated is important.

• #2 Pneumothorax Differential Diagnoses

  https://emedicine.medscape.com/article/424547-differential

  This section reviews some important points to consider in the diagnosis of pneumothoraces. […] The diagnosis of a tension pneumothorax should largely be based on the history and physical examination findings. Ultrasonography (US) in the emergency setting is increasingly being used as an adjunct to the physical examination when there is doubt regarding the diagnosis. Chest radiography or CT should be used only in those instances when the diagnosis is in doubt and when the patient is hemodynamically stable. Obtaining such imaging studies when the diagnosis of tension pneumothorax is not in question causes an unnecessary and potentially lethal delay in treatment. […] A high index of suspicion for tension pneumothorax is recommended in patients on mechanical ventilation with acute onset of hemodynamic instability, difficult ventilation with high inspiratory pressures, and worsening hypoxemia and/or hypercapnia, even with a functioning chest tube in place.

• #2 Pneumothorax – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pneumothorax/

  The diagnosis of pneumothorax is usually confirmed by chest x-ray. […] Ultrasound is becoming an increasingly accepted modality for identifying pneumothorax and is part of the eFAST. […] CT can provide information about the underlying cause (e.g., bullae in spontaneous pneumothorax). […] Tension pneumothorax is primarily a clinical diagnosis and prolonged diagnostic studies should be avoided in favor of initiating immediate treatment. […] In cases of tension pneumothorax, immediate decompression is a priority and should not be delayed by imaging. […] Indications: all patients suspected of having pneumothorax. […] Procedure: Upright PA chest x-ray in inspiration is the modality of choice. […] Supportive findings of pneumothorax include ipsilateral pleural line with reduced/absent lung markings (i.e., increased transparency).

• #2 Pneumothorax Differential Diagnoses

  https://emedicine.medscape.com/article/424547-differential

  Portable chest radiography may fail to show the pneumothorax; CT may be required for diagnosis. […] Avoid assuming that a patient with a chest tube does not have a tension pneumothorax if he or she has respiratory or hemodynamic instability. Chest tubes can become plugged or malpositioned and cease to function. In addition, improper attachment of a one-way valve to the chest tube may produce tension pneumothorax.

• #2 Traumatic Pneumothorax: Emergency Department Management

  https://www.ebmedicine.net/topics/trauma/emergency-medicine-traumatic-pneumothorax

  Pneumothorax, or air in the pleural space, is common in trauma, and has been found in up to 50% of severe polytrauma patients with chest injury. […] Although pneumothorax is traditionally diagnosed on plain film and confirmed with CT, the advent of portable ultrasonography has provided a way to rapidly diagnose pneumothorax, with a higher sensitivity than plain film. […] Patients with traumatic pneumothorax are typically treated with needle decompression or tube thoracostomy. […] However, recent literature has found that many patients can be managed conservatively via observation, or with a smaller thoracostomy such as a percutaneous pigtail catheter rather than a larger chest tube. […] Which diagnostic studies should be utilized to identify signs of pneumothorax? […] How would you manage these patients?

• #2 Traumatic pneumothorax: updates in diagnosis and management in the emergency department.

  https://vivo.weill.cornell.edu/display/pubid35467819

  Pneumothorax, or air in the pleural space, is common in trauma, and has been found in up to 50% of severe polytrauma patients with chest injury. […] Although pneumothorax is traditionally diagnosed on plain film and confirmed with CT, the advent of portable ultrasonography has provided a way to rapidly diagnose pneumothorax, with a higher sensitivity than plain film.

• #2

  https://journals.lww.com/onlinejets/fulltext/2012/05010/sonographic_diagnosis_of_pneumothorax.17.aspx

  In addition, ultrasound is the perfect modality in the emergency and critical care setting after performing certain procedures, such as a thoracentesis or the placement of a central line, to quickly confirm the presence of lung-sliding and to rule out an iatrogenic pneumothorax. […] This article offers a review of the current evidence for the use of thoracic ultrasound in the diagnosis of a pneumothorax, reviews the proper techniques used, and highlights its clinical utility.

• #2 Factors for increasing positive predictive value of pneumothorax detection on chest radiographs using artificial intelligence | Scientific Reports

  https://www.nature.com/articles/s41598-024-70780-1

  Recent studies have shown that AI algorithms perform well in detecting pneumothorax, with reported areas under the receiver operating characteristics curve ranging from 0.91 to 0.97. […] While AI algorithms have the potential to reduce missed diagnosis of pneumothorax and decrease the turnaround time for CXR from critical patients, false-positive (FP) results remain a challenge. […] Hospitals that have implemented commercial AI-based diagnostic tools have reported that the benefits of AI vary depending on the clinical context and how FP results are managed. […] Therefore, the purpose of this study was to evaluate the actual positive predictive value (PPV) of an AI based tool for pneumothorax detection on CXR. […] The PPV was significantly different between PA and AP views (88.2% vs. 20.1%).

• #2 Acute Pneumothorax Evaluation and Treatment | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27372

  The diagnostic approach varies depending on the clinical scenario. An upright chest radiograph is typically the preferred initial imaging study. However, tension pneumothorax is a clinical diagnosis, as waiting for imaging can delay life-saving treatment. […] Point-of-care ultrasound is increasingly used to evaluate pneumothorax. This modality offers greater accuracy compared to chest x-rays while avoiding radiation exposure. […] The distinction between small and large pneumothoraces is based on the distance between the lung margin and the chest wall on imaging. […] Chest x-rays underestimate the size of pneumothorax and may also reveal other findings, such as hydropneumothorax, particularly when obtained in the upright position. […] In cases where clinical suspicion remains high despite a negative chest x-ray, a CT scan can provide a more accurate assessment of pneumothorax size and detect subtle or loculated air collections that may not be visible on standard radiographs.

• #2 Pneumothorax – diagnosis and management in the ED – Pedmore Medical

  https://pedmore-medical.com/pneumothorax-diagnosis-and-management-in-the-ed/

  If a tension pneumothorax is suspected and the patient is unstable, the attending clinician should proceed with decompression. […] The bottom line is that when a patient presents to the ED with chief complaints of chest pain and shortness of breath, a clinician should at least consider a pneumothorax diagnosis. […] If a tension pneumothorax is suspected, decompression should be performed before proceeding with a detailed history and examination. […] Prompt diagnosis and appropriate treatment is necessary to prevent severe, long-term complications.

• #3 Pneumothorax | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pneumothorax?lang=us

  Pneumothorax (PTX) refers to the presence of gas in the pleural space which allows the parietal and visceral pleura to separate and the lung to collapse. The clinical consequences range from negligible to hemodynamic collapse and death. […] Presentation is variable and may range from no symptoms to severe dyspnea with tachycardia and hypotension. In patients with a tension pneumothorax, presentation may include distended neck veins and tracheal deviation, cardiac arrest, and death in the most severe cases. […] A pneumothorax is, when looked for, usually easily appreciated on erect chest radiographs. Typically they demonstrate: visible visceral pleural edge is seen as a very thin, sharp white line; no lung markings are seen peripheral to this line; peripheral space is radiolucent compared to the adjacent lung; lung may completely collapse; mediastinum should not shift away from the pneumothorax unless a tension pneumothorax is present. […] Provided lung windows are examined, a pneumothorax is very easily identified on CT, and should pose essentially no diagnostic difficulty.

• #3 Diagnosis and Management of Spontaneous Pneumothorax | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0915/p1398.html

  Spontaneous pneumothorax occurs in persons who do not have clinically apparent lung disease. […] Patients with spontaneous pneumothorax do not have clinically apparent lung disease. However, studies have found that 76 to 100 percent have subpleural bullae diagnosed by video-assisted thoracoscopic surgery. […] The physical examination may be normal in patients with a small pneumothorax (less than 15 percent of the hemithorax). Tachycardia is the most common finding and, depending on the amount of lung involved, other physical findings include decreased chest wall movement, a hyperresonant percussion note, diminished fremitus and diminished or decreased breath sounds. […] The initial treatment of spontaneous pneumothorax involves removing air from the subpleural space. […] Surgical intervention is rarely necessary in patients with primary pneumothorax and does not become a consideration unless the air leak persists for four to seven days. […] The decision to use sclerosing agents such as talc to prevent recurrence must be individualized.

• #3 Tension Pneumothorax : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/tension-pneumothorax/

  Signs and Symptoms of tension pneumothorax include symptoms and signs of pneumothorax and (pending) cardiorespiratory compromise: […] Imaging: Classically, tension pneumothorax is a clinical diagnosis. […] In suspected tension pneumothorax not in extremis (i.e., time permits), Point of Care US (POCUS) or X-ray improves diagnostic accuracy and avoids risks of unnecessary pleural decompression: […] Point-of-care ultrasound: 94% Sn, 100% Sp for pneumothorax. […] Chest X-ray: Pneumothorax: Visible lung edge. […] No X-ray findings are highly sensitive for tension pneumothorax: Ipsilateral increased intercostal spaces. […] Tension Pneumothorax patients should generally be admitted to hospital for close observation and stabilization, especially if persistent air leak, bronchopleural fistula, concerns regarding patient reliability, or other concurrent indications for admission. […] Maintain high index of suspicion for tension pneumothorax in intubated patients. […] Clinical features – High: Clinical features consistent in various diagnostic guidelines. […] Multiple studies show high sensitivity and specificity (≥90%) for pneumothorax detection with US.

• #3 Pneumothorax: Symptoms, diagnosis and treatment. Clínica Universidad de Navarra

  https://www.cun.es/en/diseases-treatments/diseases/pneumothorax

  The diagnosis of pneumothorax is made by the symptoms, in addition to the physical and radiological examination. […] In the physical examination it can be appreciated tachypnea, decrease or abolition of the physiological vesicular murmur to the auscultation, as well as tympanism to the percussion of the thorax and decrease of the vocal vibrations. […] The diagnosis is confirmed with the performance of a chest X-ray (preferably performed in forced expiration), in which the lung collapse is appreciated.

• #3 Pneumothorax – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pneumothorax

  Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical criteria and chest x-ray. The diagnosis is suspected in patients whose condition is stable but who have dyspnea or pleuritic chest pain and is usually confirmed with upright inspiratory chest x-ray. Radiolucent air and the absence of lung markings juxtaposed between a shrunken lobe or lung and the parietal pleura are diagnostic of pneumothorax. The diagnosis can also be made using bedside ultrasonography in the absence of underlying lung disease. […] Diagnosis is by upright chest x-ray or ultrasonography, except for tension pneumothorax, which is diagnosed clinically as soon as suspected.

• #3 Acute Pneumothorax Evaluation and Treatment | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27372

  The diagnostic approach varies depending on the clinical scenario. An upright chest radiograph is typically the preferred initial imaging study. However, tension pneumothorax is a clinical diagnosis, as waiting for imaging can delay life-saving treatment. […] Point-of-care ultrasound is increasingly used to evaluate pneumothorax. This modality offers greater accuracy compared to chest x-rays while avoiding radiation exposure. […] The distinction between small and large pneumothoraces is based on the distance between the lung margin and the chest wall on imaging. […] Chest x-rays underestimate the size of pneumothorax and may also reveal other findings, such as hydropneumothorax, particularly when obtained in the upright position. […] In cases where clinical suspicion remains high despite a negative chest x-ray, a CT scan can provide a more accurate assessment of pneumothorax size and detect subtle or loculated air collections that may not be visible on standard radiographs.

• #3

  https://journals.lww.com/onlinejets/fulltext/2012/05010/sonographic_diagnosis_of_pneumothorax.17.aspx

  Lung sonography has rapidly emerged as a reliable technique in the evaluation of various thoracic diseases. One important, well-established application is the diagnosis of a pneumothorax. […] Sonographic signs, including lung sliding, B-lines or comet tail artifacts, A-lines, and the lung point sign can help in the diagnosis of a pneumothorax. […] Ultrasound has a higher sensitivity than the traditional upright anteroposterior chest radiography (CXR) for the detection of a pneumothorax. […] The diagnosis of a pneumothorax is usually made with a combination of clinical signs and symptoms, which may be subtle, and plain chest radiography. […] In these critical situations where a subtle pneumothorax may be missed, a quick bedside lung ultrasound may expedite the diagnosis, treatment, and resuscitation of a patient who may have otherwise decompensated.

• #3 Pneumothorax with the use of POCUS | Show me the POCUS

  https://www.showmethepocus.com/pneumothorax

  Pneumothorax is commonly associated with both blunt and penetrating chest injury and is a leading cause of preventable morbidity and mortality. Its diagnosis is frequently relied on a series of signs and symptoms and x ray findings. Early detection is critical as a delay, specially in those who are receiving mechanical ventilation can lead to progression of the pneumothorax and hemodynamic instability. […] Ultrasound has a well stablished role in the diagnosis of a traumatic pneumothorax. Based on international recommendations, lung ultrasound should be used in clinical settings when pneumothorax is in the differential diagnosis. It more accurately rules in the diagnosis of pneumothorax than supine anterior chest radiography. Lung ultrasound more accurately rules out the diagnosis of pneumothorax than supine anterior chest radiography.

• #3

  https://journals.lww.com/onlinejets/fulltext/2012/05010/sonographic_diagnosis_of_pneumothorax.17.aspx

  In addition, ultrasound is the perfect modality in the emergency and critical care setting after performing certain procedures, such as a thoracentesis or the placement of a central line, to quickly confirm the presence of lung-sliding and to rule out an iatrogenic pneumothorax. […] This article offers a review of the current evidence for the use of thoracic ultrasound in the diagnosis of a pneumothorax, reviews the proper techniques used, and highlights its clinical utility.

• #3 Coming up for Err: Missed Diagnosis in a Patient with Recurrent Pneumothorax | PSNet

  https://psnet.ahrq.gov/web-mm/coming-err-missed-diagnosis-patient-recurrent-pneumothorax

  The patients CT scan showed classic features of lymphangioleiomyomatosis (LAM), a rare cystic lung disease that is most often seen in young women. […] The diagnosis of LAM can be made based on these characteristic CT findings along with blood testing for VEGF-D3 (vascular endothelial growth factor D), which is specific for LAM if it is higher than 800pg/ml. […] It has been recommended that clinicians consider ordering a CT scan of the chest for patients presenting with an unexplained spontaneous pneumothorax. […] In this case, at the initial ED presentation, the CT scan would likely have demonstrated diffuse cystic lung disease, which in retrospect appears to have been misdiagnosed by the ED physician, radiologist, and first pulmonary consultant as mild emphysema with small cysts and blebs.

• #3 Pneumothorax: Improving Diagnosis and Management in Premenopausal Patients – Clinical Advisor

  https://www.clinicaladvisor.com/features/pneumothorax-diagnosis-management-premenopausal/

  Pneumothorax diagnostics can be confirmed by an upright posteroanterior chest radiograph, which also can be used to estimate the size of the pneumothorax. […] In patients with a small PSP, however, computed tomography (CT) may be necessary to diagnose the presence of pleural air. […] The diagnosis of catamenial pneumothorax is often made clinically based on patient history of shortness of breath and recurrent chest pain that is temporally related to the menstrual cycle. […] In these cases, CT and magnetic resonance imaging (MRI) are typically used to confirm the diagnosis of catamenial pneumothoraxes. […] Chest radiography can diagnose pneumothorax but plays a minimal role in the diagnosis of pleural and diaphragmatic lesions, which are typically associated with catamenial pneumothoraxes.

• #3 Tension pneumothorax | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/tension-pneumothorax?lang=us

  Tension pneumothoraces occur when progressive accumulation of intrapleural gas causes hemodynamic compromise. Urgent placement of a pleural drain can be life-saving and avert cardiorespiratory arrest. […] The diagnosis should be made from the clinical features and treatment should not be delayed. […] Urgent pleural drainage is life-saving and should not be delayed for radiographic confirmation. […] The diagnosis is a clinical one. Radiographic features do not measure actual intrapleural pressure or cardiorespiratory compromise.

• #3 Traumatic pneumothorax: updates in diagnosis and management in the emergency department.

  https://vivo.weill.cornell.edu/display/pubid35467819

  Pneumothorax, or air in the pleural space, is common in trauma, and has been found in up to 50% of severe polytrauma patients with chest injury. […] Although pneumothorax is traditionally diagnosed on plain film and confirmed with CT, the advent of portable ultrasonography has provided a way to rapidly diagnose pneumothorax, with a higher sensitivity than plain film.

• #3 Understanding Pneumothorax

  https://lakecountyin.gov/departments/health/nursing-clinic/diseases-and-conditions/respiratory/understanding-pneumothorax

  Diagnosing pneumothorax involves a combination of clinical evaluation and diagnostic tests: […] Medical History and Physical Examination: Assessment of symptoms, recent trauma or medical procedures, and physical examination to identify signs of pneumothorax, such as decreased breath sounds and altered percussion notes. […] Imaging Tests: – Chest X-ray: A primary diagnostic tool that reveals the presence of air in the pleural space and the extent of lung collapse. – High-Resolution Computed Tomography (HRCT) Scan: Provides detailed images of the chest and pleural space, helping to identify smaller pneumothoraces or underlying lung conditions. […] Ultrasound: Can be used to detect pneumothorax, especially in emergency settings, and to guide procedures like thoracentesis or chest tube placement.

• #4 Pneumothorax: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/424547-overview

  History and physical examination remain the keys to making the diagnosis of pneumothorax. Examination of patients with this condition may reveal diaphoresis and cyanosis (in the case of tension pneumothorax). Affected patients may also reveal altered mental status changes, including decreased alertness and/or consciousness (a rare finding). […] Although laboratory and imaging studies help determine a diagnosis, tension pneumothorax primarily is a clinical diagnosis based on patient presentation. Suspicion of tension pneumothorax, especially in late stages, mandates immediate treatment and does not require potentially prolonged diagnostic studies. […] When pneumothorax is suspected, confirmation by chest radiography affords additional information beyond confirmation, such as the extent of pneumothorax, potential causes, a baseline study from which to go forward, and assistance with the therapeutic plan.

• #4

  https://journals.lww.com/onlinejets/fulltext/2012/05010/sonographic_diagnosis_of_pneumothorax.17.aspx

  Ultrasound has a well-known established role in the diagnosis of a traumatic pneumothorax. […] The utility of thoracic ultrasound for diagnosing a pneumothorax was compared to chest x-ray (CXR) alone, a composite standard (CXR, chest, and abdomen Computed tomography (CT) scans, clinical course, and invasive interventions), and to the gold standard CT scan (CT only). […] Although CT scan remains the gold standard, they concluded that ultrasound was more sensitive in identifying occult traumatic pneumothoraces compared to CXR. […] Several other studies highlight the utility of ultrasound compared to CXR for the diagnosis of pneumothorax in the Emergency Department. […] The sensitivity of ultrasound in certain studies has been similar to that found in CT scan, which is still considered to be the gold standard for the detection of a pneumothorax.

• #4 Pneumothorax with the use of POCUS | Show me the POCUS

  https://www.showmethepocus.com/pneumothorax

  In extreme emergency, absence of any movement of the pleural line with lung sliding or lung pulse, coupled with absence of B-lines allows prompt and safe diagnosis of pneumothorax without the need for searching the lung point as we will discuss here. […] This sign is pathognomonic of a pneumothorax and it is a finding occurs at the border of a pneumothorax. It is due to sliding lung intermittently coming into contact with the air that has accumulated in the chest. Essentially you see the air because lung sliding stops from occurring. However even with a large pneumothorax you may not see a lung point.

• #5

  https://journals.lww.com/onlinejets/fulltext/2012/05010/sonographic_diagnosis_of_pneumothorax.17.aspx

  The average time to perform this examination varies from two to three minutes; less than one minute to rule out a pneumothorax and several minutes to rule it in. […] In a pneumothorax, there is air present that separates the visceral and parietal pleura and prevents visualization of the visceral pleura. […] The negative predictive value for lung sliding is reported as 99.2100%, indicating that the presence of sliding effectively rules out a pneumothorax. […] The lung-point sign occurs at the border of a pneumothorax. […] The lung-point sign is 100% specific for pneumothorax and defines its border. […] Thoracic sonography for the detection of pneumothorax has become a well-established modality in the acute care setting. […] The traditional upright AP radiograph has become less important due to its poor sensitivity in diagnosing a pneumothorax compared to ultrasound.

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