PTX;  Px

Pneumothorax is the accumulation of gas or air into the pleural cavity, resulting to a collapsed lung. The physiological response to increasing pleural pressure is for the respiratory rate and the tidal volume to increase.

Diagnosis involves a high degree of suspicion as a missed diagnosis carries high morbidity and potentially mortality; the usual clinical findings described in the literature may not all be present: hyperresonance on the affected side of the chest, unequal chest expansion, tracheal deviation to the affected site, and hypoxia.

Prior to imaging modalities, diagnosis was established using clinical skills. Chest radiograph will demonstrate a pneumothorax with collapsed lung, mediastinal and tracheal deviation towards the affected side. Sometimes, location makes it difficult to diagnose, i.e., anterior pneumothorax, which will appear as the “deep sulcus” sign.

Newer modalities especially ultrasound (USS) (Donmez et al. 2012) imaging have been utilized to successfully diagnose pneumothorax as the cause. The USS can then be placed over the lung fields, and absence of the “sliding sign” can help diagnose pneumothorax. Thoracic CT scan is the “gold standard” for the early detection of a pneumothorax in trauma patients (Omar et al. 2011; Bridges et al. 1993).

The treatment depends upon the symptoms and size of the pneumothorax. Small pneumothoraces which are asymptomatic in a stable patients may just be monitored with regular examination and periodic chest radiographs (Wilson et al. 2009). However, symptomatic pneumothoraces require intervention. Definitive treatment is with insertion of a chest tube in the 5th intercostal space in the midaxillary on the affected site.