%0 Journal Article
%T Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients
%A Hesham R Omar
%A Devanand Mangar
%A Suneel Khetarpal
%A David H Shapiro
%A Jaya Kolla
%A Rania Rashad
%A Engy Helal
%A Enrico M Camporesi
%J International Archives of Medicine
%D 2011
%I BioMed Central
%R 10.1186/1755-7682-4-30
%X The concept of occult pneumothorax is well accepted among the surgical trauma literature [1-5]. In trauma patients, because of restrictions regarding cervical spine immobilization, AP chest radiograph is usually utilized to detect intrathoracic pathology. This report emphasizes how AP chest radiograph can dangerously delay the recognition of a pneumothorax. More advanced imaging modalities including Chest CT scan or ultrasonography is therefore manadatory to exclude the diagnosis.A 24-year-old male presented to the ER after a motor vehicle accident. On admission the patient was confused with a Glasgow coma score of 14/15. CT brain revealed brain edema and fracture skull base. Chest exam and arterial blood gases were satisfactory. AP chest X-ray revealed no evidence of pneumothorax as demonstrated in Figure 1 panel A, adapted from Omar et. al. [6] CT chest performed immediately after the X-ray revealed a right sided pneumothorax (Figure 1 panel B), adapted from Omar et. al [6]This case represents an example of a true occult pneumothorax where an AP chest X-ray failed to show an existing pneumothorax. This emphasizes the importance of chest CT in any trauma victim who is tachypnic or hypoxic when the initial AP chest radiograph appears normal. This is especially important in patients expected to be maintained on positive pressure ventilation.A 29-year-old restrained driver was involved in a T-bone vehicular accident. At the scene of the accident the patient's Glasgow coma score was 4/15. The patient was intubated for airway protection and sent to the ER. While in the ER, an AP chest X-ray was completed (Figure 2 panel a), adapted from Omar et. al, [6] which revealed a mechanically ventilated patient with diffuse airspace opacities prominently located in the left lower lung field. In the setting of trauma, this was interpreted as lung contusions.The patient was immediately sent for a chest CT scan (Figure 2 panel b), adapted from Omar et. al, [6] that was performed 15
%U http://www.intarchmed.com/content/4/1/30