chapter  7
10 Pages

Pneumothorax Introduction

Pneumothorax is a common disorder in the critically ill, the trauma patient, and after iatrogenic procedures, and can be life threatening, requiring expeditious diagnosis and treatment.1 Bedside radiography misses a high percentage of cases2-6 and may underestimate the real volume involved. This is especially true with supine x-rays, which are notoriously inaccurate when looking for pneumothoraces, with sensitivities in blunt trauma of between 28 and 75%.7 This is because free air layering anteriorly is projected over normal lung posteriorly and is difficult to see. Even tension pneumothoraces can be radio-occult,8 and CT cannot be routinely used for this indication. Overuse of CT scanning can also lead to excessive irradiation of the patient, increased costs, and can subject patients to potential risks with medical transport. Bedside ultrasound provides a noninvasive means to quickly assess for a pneumothorax as well as other lifethreatening lung disorders with a sensitivity that may be an improvement on the current gold standard.9