Abstract

Background
Occult pneumothorax defined as a pneumothorax that is detected by computed tomography (CT) scaning, not routine supine screening chest roentgenograms. Optimal treatment for blunt trauma occult pneumothoraces has not been defined. Methods: Chest & abdominal CT scans of all trauma patients about 1-year period were retrospectively reviewed. To help guide management, we used Wolfman et al’s classification, based on size and location: (a) minuscule ( <1 cm in greatest thickness, seen on four or fewer); (b) anterior ( >1cm in greatest thickness, but not extending beyond the midcoronal line); (c) anterolateral (extending beyond the midcoronal line). Results: 43 patients with 48 pneumothoraces were enrolled. 16 of 17 cases with minuscule pneumothorax were observed without complications; one of 17 cases had chest tube placement. 19 of 25 cases with anterior pneumothroax were observed and resolved without complication; six had chest tube placement. Three of six cases with anterolateral pneumothorax were observed and resolved without complication; The others had chest tube placement. 16 cases in each group received positive pressure ventilation or general anesthesia. 14 of 16 cases were no difference in overall complication rate. Conclusions: Our data suggest that it is possible to safely observe patients of minuscule and anterior pneumothorax. But anterolateral pneumothorax must be treated with closed thoracostomy. Occult pneumothroaces can be safely observed in patients with blunt trauma injury regardless of the need for positive pressure ventilation.

• Keywords: Occult pneumothroax, Computed tomography, Tube thoracostomy