Chest
Clinical InvestigationsChest Radiograph—A Poor Method for Determining the Size of a Pneumothorax
Section snippets
Lung Model Experiment
A model of a pneumothorax was constructed using a water-filled plastic bag (lung) fitted into a plastic chamber (hemithorax) of the same size. The size and shape of the lung model were chosen to resemble the human hemithorax and lung as closely as possible (a cylinder of 2,500-ml volume, narrowing at the top). Water from the plastic bag was drawn off in incremental steps, and a CT scan was done after each step using a slice thickness of 12 mm. As water left the plastic bag, it decreased in size
RESULTS
The results from the lung model experiment are displayed in Figure 1. There is good agreement between the volume of extracted water and the volume of air measured by the CT scan (r = 0.99). In the clinical part of the study, the correlation between the decrease in lung volume measured by radiograph and the volume measured by CT scan is plotted in Figure 2. The correlation is poor regardless of which method is used for calculation of volumes (r = 0.71), although it differs significantly from
DISCUSSION
Every clinician faced with a case of pneumothorax has to make a choice of treatment strategy. This choice is based on the clinical condition, age, history of the patient and also on the therapeutic traditions of the hospital. The decision whether to use active treatment is to a large extent also influenced by the size of the pneumothorax. 1, 2, 3, 4, 5, 6
Chest radiography has been the most important investigational technique in patients with pneumothorax for almost a century. It is frequently
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Using thoracic ultrasonography to accurately assess pneumothorax progression during positive pressure ventilation a comparison with ct scanning
2013, ChestCitation Excerpt :The most striking findings were that the patients whose occult PTXs expanded were > 70 times more likely to require chest tube drainage and that mechanical ventilation tripled this risk.21 This study used CXR imaging to assess the PTX progression, despite its being a poor method for detecting PTXs and one that underestimates the size.12,22 Two CT scan-based PTX classification systems, a linear size (thickness)-based algorithm23,24 and computer-aided volumetric measurements,25 have been suggested as potential guides for making treatment decisions, but no consensus on the clinical usefulness of these PTX scoring systems has been established.21
MDCT quantification is the dominant parameter in decision-making regarding chest tube drainage for stable patients with traumatic pneumothorax
2012, Computerized Medical Imaging and GraphicsCitation Excerpt :Traditionally, pneumothorax has been diagnosed and its size estimated by use of chest radiography (CXR). A study showed that, by use of an experimental model of pneumothorax, the 2D image analysis on CXR gave a poor estimation of the volume of pneumothorax, regardless of the methods chosen for calculation [21]. With the rapid development of multi-detector CT (MDCT), CT scanning of trauma patients has become the primary method of trauma survey, which provides higher sensitivity and specificity than does either ultrasound or CXR [22,23].
Evidence-based management of paediatric primary spontaneous pneumothorax
2009, Paediatric Respiratory ReviewsCitation Excerpt :A left-sided preponderance has been reported in paediatric studies (range 54–67%),13,22 consistent with the adult literature. Estimation of pneumothorax size has traditionally been based on the erect PA CXR; however, this is known to be a poor predictor of outcome.23 Physicians commonly overestimate the size of pneumothoraces in adults,24 making a more systematic approach attractive.
Pneumothorax and Barotrauma
2008, Critical Care Medicine: Principles of Diagnosis and Management in the AdultManagement of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010
2010, ThoraxCitation Excerpt :There are difficulties with this approach, including the fact that some pneumothoraces are localised (rather than uniform), so that measurement ratios cannot be applied. The shape of the lung cannot be assumed to remain constant during collapse.46 The measurement of the ratio of the lung to the hemithorax diameter is accurate and relatively easy with the new PACS systems by means of a cursor, once familiar with the PACS auxiliary functions.
Methods of measurement for pneumothorax in pediatric patients: a systematic review
2024, Pediatric Surgery International
Manuscript received March 19, revision accepted June 11.