Simple Pneumothorax

Fig 10. Simple pneumothorax

Common and readily missed on CXR, proven on CT, hence the term ‘occult pneumothorax’.

Beware a sub-pulmonary pneumothorax – look for the deep sulcus sign (look out for one of these in the clinical cases at the end of the session).

In general, those visible on chest x-ray (CXR) should be treated with a chest drain; large bore, if a haemothorax coexists.

Small, occult pneumothoraces may be observed, even if the patient is ventilated [6]. About a third may deteriorate clinically, necessitating a drain.  Discuss management options with your ITU/anaesthetic colleagues, to whom you are transferring care.

Medium-term/long-term, patients with traumatic pneumothorax may wish to fly.  No guideline regarding the safe timing of this exists.

A pragmatic approach may be to adopt British Thoracic Society guidelines for spontaneous pneumothorax — flying permissible, once chest x-ray confirms resolution of the pneumothorax.