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Letters to the editor
Estimation of size of pneumothorax under the new BTS guidelines
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  1. S S Chan1
  1. 1Prince of Wales Hospital, Hong Kong; stewart_chan@hotmail.com

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    I read with interest the new BTS guidelines for the management of spontaneous pneumothorax.1 Henry and colleagues acknowledged that the plain radiograph was a poor method of quantifying the size of a pneumothorax, yet then went on to use one radiographic method of assessment to estimate the degree of lung collapse.

    Under the new guidelines, the size of a pneumothorax is divided into “small” or “large” depending on the presence of a visible rim of <2 cm or ⩾2 cm between the lung margin and the chest wall. The authors then explained in detail how these distances could be used to estimate the percentage of lung collapse. A schematic figure was even used to illustrate the calculations. However, the method used by the authors (the method of Axel),2 like most other methods, has been found to be unsatisfactory for determining pneumothorax size under clinical conditions.3

    I do not see any evidence that the new classification is in any way better than the old one. The calculations based on the distance of the rim correlated poorly with the actual size of …

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