Xray Vision: Chest Pain Answer

-size of pneumothorax can be calculated from various formulas such as the Light Index but it has not shown to be accurate

-per American College of Chest Physicians, a small pneumothorax is ≤3 cm from the thoracic apex to lung cupola

-per British Thoracic Society, small is considered to be <2cm from thoracic apex to lung cupola

Adapted from Henry M, Arnold T, Harvey J, et al: BTS guidelines for the management of spontaneous pneumothorax. Thorax 58: ii39, 2003; and Currie GP, Allrui R, Christie GL, Legge JS: Pneumothorax: an update. Postgrad Med J 83: 461, 2007.

-depends more on clinical status than size of pneumothorax

-oxygen 3-10L helps increase resorption by 3-4 folds

Treatment of Pneumothorax

Condition	Treatment Options
Small primary pneumothorax	Observation for 6 h, discharge if no symptoms and return for check if symptoms reoccur or in 24 h
	or
	Small-size catheter aspiration with immediate catheter removal, then observe for 6 h, discharge if no symptoms and return for check if symptoms reoccur or in 24 h
	or
	Small-size catheter or small-size chest tube insertion, Heimlich valve or water-seal drainage, and admission
Small secondary pneumothorax	Small-size catheter or small-size chest tube insertion, Heimlich valve or water-seal drainage, and admission
Large pneumothorax, either primary or secondary, or bilateral pneumothoraces	Moderate-size chest tube and admission; large-size chest tube if fluid or hemothorax present; water-seal drainage and admission
Tension pneumothorax	Immediate needle decompression followed by moderate or large-size chest tube insertion, water-seal drainage, and admission