Other Investigations

In addition to the PA chest radiograph, there are a number of other investigations available [9].

CT

CT is considered the gold standard for identifying pneumothoraces but the radiation exposure is only justified in cases where radiographs are difficult to interpret or specific drain placement is required e.g. bullous lung disease, loculated pneumothoraces, surgical emphysema.

Ultrasound

Ultrasounds show promise with reports of sensitivities at identifying pneumothoraces in trauma and post procedure (e.g. lung biopsy) patients of ~95%. However, it is highly user dependent and for patients with suspected spontaneous pneumothoraces, radiography has the advantage of identifying unexpected causes of pleuritic pain e.g. infection, carcinoma. Having said this, with the increasing use of ultrasound in Emergency Medicine, in the hands of an experienced user it can now reliably detect pneumothorax better than an anteroposterior chest radiograph.

Arterial gas monitoring

Arterial gas monitoring may demonstrate hypoxia but the information gained is unlikely to alter the management plan. An exception is when supplemental oxygen is being administered to patients with pneumothoraces secondary to COPD.