Pneumothorax

Tension pneumothorax is a clinical diagnosis requiring immediate pleural decompression when suspected in an unstable patient; imaging should not delay treatment. Pediatric emergency guidance similarly directs immediate needle thoracostomy for unstable symptomatic patients. AHA Journals+1AHA JournalsSpecial Resuscitation Situations | Circulationpublications aapPneumothorax and Pneumomediastinum | Pediatric Care ...

After emergency needle decompression, proceed to definitive pleural drainage. Historical resuscitation guidance specifies bilateral needle decompression followed by bilateral tube thoracostomies when bilateral tension pneumothoraces are diagnosed. AHA JournalsAHA JournalsSpecial Resuscitation Situations | Circulation

Chest radiography remains the conventional diagnostic test; a pleural line with absent peripheral lung markings is described as the radiographic diagnostic standard in pediatric review literature. publications aappublications aapSpontaneous Pneumothorax and Pneumomediastinum In clinically stable adults, radiography also provides a baseline for interval assessment and follow-up.

Thoracic ultrasonography can improve bedside detection when a supine radiograph is insensitive. A meta-analysis compared AP chest radiography with transthoracic ultrasonography for pneumothorax diagnosis, and trauma studies report ultrasound to be more sensitive than supine radiography and as sensitive as CT for traumatic pneumothorax detection. journal chestnet+2journal chestnetDiagnosis of Pneumothorax by Radiography and ...journal chestnetReferences in Test Characteristics of Ultrasonography for the ...pubs rsnaTraumatic Pneumothorax Detection with Thoracic US Ultrasound performance and interpretation remain operator- and context-dependent; it should not delay decompression of an unstable patient. AHA Journals+1AHA JournalsSpecial Resuscitation Situations | Circulationpublications aapPneumothorax and Pneumomediastinum | Pediatric Care ...

CT is more effective than radiography for detecting and measuring pneumothorax. NatureNatureAutomatic and efficient pneumothorax segmentation from ... Reserve it for situations in which radiography or ultrasound is discordant with the clinical picture, an occult pneumothorax would change management, or anatomic characterization is needed for procedural or surgical planning.

Available first-line strategies include observation with supplemental oxygen, ambulatory drainage devices where available, percutaneous aspiration, chest drain insertion, and, for selected patients, VATS or thoracotomy. BMJBMJPneumothorax - Symptoms, diagnosis and treatment | BMJ Best Practice The supplied evidence does not support a single universal size threshold, device specification, or drainage protocol for all adult pneumothoraces; local pathways should therefore align with current specialty guidance and procedural expertise.

For large primary spontaneous pneumothorax, drainage or simple aspiration are described as first-line options. BMJBMJAmbulatory management of primary spontaneous ... A contemporary trial protocol evaluating conservative management uses initial observation, repeat chest radiography at 4 hours or later, discharge only if clinical and radiographic stability persists, and planned imaging follow-up; this is a study protocol rather than established universal standard of care. clinicaltrialsclinicaltrialsStudy Details | NCT07331805 | Conservative Management in Primary Spontaneous Pneumothorax: a Multicenter Randomized Non-inferiority Study | ClinicalTrials.gov

When a chest tube is used, management should include reassessment of air leak, lung expansion, drainage, and complications. An FDA device study protocol used suction of 20 to 25 cm H2O for the first 24 hours, followed by water seal if no air leak; tube removal required absence of air leak after water seal and adequate expansion without meaningful pneumothorax enlargement. accessdata fdaaccessdata fda[PDF] - 1 - SUMMARY OF SAFETY AND EFFECTIVENESS DATA (SSED) I ... This is protocol-specific evidence, not a universal chest-tube management mandate.

The BTS guideline advises considering elective surgery after a second ipsilateral or first contralateral pneumothorax. It also identifies circumstances in which prevention of recurrence may justify elective surgery after the first event, including divers, airline pilots, military personnel, and patients whose first event was tension pneumothorax. BMJBMJBritish Thoracic Society Guideline for pleural disease

VATS access can be considered for surgical pleurodesis in adults. BMJBMJBritish Thoracic Society Guideline for pleural disease Thoracotomy with pleurodesis can be considered when the lowest level of recurrence risk is required for a specific high-risk occupation. BMJBMJBritish Thoracic Society Guideline for pleural disease Surgical pleurodesis and/or bullectomy are options for spontaneous pneumothorax. BMJBMJBritish Thoracic Society Guideline for pleural disease

The decision should integrate recurrence consequences, occupational exposure, future access to emergency care, pulmonary reserve, and patient preference. The supplied guideline excerpt supports these indications but does not provide a recurrence percentage, uniform operative technique, or U.S.-specific occupational clearance policy.

All patients should receive discharge and activity advice after pneumothorax. BMJBMJBritish Thoracic Society Guideline for pleural disease For conservatively managed patients, the ongoing trial protocol requires repeat radiography at 4 hours or later before discharge if stability persists, a clinic review with chest radiography at about 1 week, and approximately 2-weekly imaging until resolution. clinicaltrialsclinicaltrialsStudy Details | NCT07331805 | Conservative Management in Primary Spontaneous Pneumothorax: a Multicenter Randomized Non-inferiority Study | ClinicalTrials.gov The protocol provides a useful operational model but is not itself a completed efficacy trial or universal discharge standard.

Provide clear return precautions for worsening breathlessness, chest pain, syncope, or other evidence of deterioration. Ensure that patients managed outside the hospital can obtain prompt reassessment and rescue drainage if symptoms or imaging worsen. clinicaltrialsclinicaltrialsStudy Details | NCT07331805 | Conservative Management in Primary Spontaneous Pneumothorax: a Multicenter Randomized Non-inferiority Study | ClinicalTrials.gov