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Open Access Case report

Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

Hesham R Omar13*, Devanand Mangar23, Suneel Khetarpal4, David H Shapiro4, Jaya Kolla3, Rania Rashad5, Engy Helal6 and Enrico M Camporesi37

Author Affiliations

1 Departement of Internal Medicine, Mercy Hospital and Medical Center. Chicago, Illinois, USA

2 Department of Anesthesiology; Tampa General Hospital; Tampa, Florida, USA

3 Florida Gulf to Bay Anesthesiology, Tampa, Florida, USA

4 Department of Surgery, University of South Florida, Tampa, Florida, USA

5 Department of Critical Care Medicine, Cairo University Hospital, Cairo, Egypt

6 Emergency Department, Elagouza Hospital, Cairo, Egypt

7 Department of Surgery/Anesthesiology, University of South Florida, Tampa, Florida, USA

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International Archives of Medicine 2011, 4:30  doi:10.1186/1755-7682-4-30

Published: 27 September 2011

Abstract

Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.