Abstract
Objectives
We sought to assess the anatomical distribution of traumatic pneumothoraces (PTXs)
on chest computed tomography (CT) to develop an optimized protocol for PTX screening
with ultrasound in the emergency department (ED).
Methods
We performed a retrospective review of all chest CTs performed in one ED between January
2005 and December 2008 according to presence, location, and size of PTX. Pneumothoraces
were then measured and categorized into 14 anatomical regions for each hemithorax.
Results
A total of 277 (3.8%) PTXs were identified, with 26 bilateral PTX, on 3636 chest CTs
performed during the study period. Etiology was blunt (85%) or penetrating trauma
(15%). Eighty-three (45%) PTXs were radiographically occult on initial chest x-ray.
One hundred eighty-three (66%) PTX had no chest tube at the time of CT. For both hemithoraces,
the distribution demonstrated increasing PTX frequency and size from lateral to medial
and from superior to inferior. Region 12 (parasternal, intercostal spaces [ICS] 7-8)
was involved in 68% of PTX on either side; region 9 (parasternal, ICS 5-6), in 67%
on the left and in 52% on the right; and region 11 (lateral to midclavicular line,
ICS 7-8), in 46% on the left and in 53% on the right. The largest anterior-to-posterior
PTX dimension was seen in region 12.
Conclusions
Our results indicate that 80.4% of right- and 83.7% of left-sided traumatic PTXs would
be identified by scanning regions 9, 11, and 12. These findings suggest that a standardized
protocol for PTX screening with ultrasound should include these regions.
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Article Info
Publication History
Published online: September 12, 2011
Accepted:
June 21,
2011
Received in revised form:
June 10,
2011
Received:
May 7,
2011
Footnotes
☆Previous affiliations: During the study period, Drs Mennicke and Goldflam were affiliated with the Department of Emergency Medicine at Brigham and Women's Hospital in Boston, and Drs Gulati and Oliva were affiliated with the Department of Emergency Radiology at Brigham and Women's Hospital in Boston.
☆☆Data from this article were presented at the 2010 American Institute of Ultrasound in Medicine Annual Convention on March 27th in San Diego, CA.
★Funding: This study was supported by a Faculty Seed Grant of the Department of Emergency Medicine at Brigham and Women's Hospital in Boston.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
