Introduction
Pneumothorax and physiology of respiration
Grading of air Leak
Imaging
Radiographs
Ultrasound
CT
Z axis coverage | IV Contrast | Oral contrast* | |
---|---|---|---|
Initial noncontrast | Thoracic inlet – below diaphragm | None | None |
Second phase with IV and oral contrast | Thoracic inlet – below diaphragm | 50–75 cc at 2–3 cc/s, images acquired at 40 sec delay | 75–300 mL of an aqueous solution consisting of IV iodinated contrast material Omnipaque 350 |
Prone/Decubitus (if needed) | Limited over region of suspicious perforation | None | 50 mL of an aqueous solution consisting of IV iodinated contrast material Omnipaque 350 |
Quantifying pneumothorax
Persistent pneumothorax/air leak
Cause | Examples |
---|---|
Mimics | Skin fold Companion shadow Bulla Eloessar flap Ex vacuo |
Chest Tube | Kink Obstruction Malposition Incomplete seal |
Bronchopleural fistula (BPF) | Bronchial stump dehiscence Iatrogenic Traumatic Erosive |
Alveolopleural fistula (APF) | Ruptured bulla Traumatic Necrotizing pneumonia Ulcerated Lung cancer Metastases: osteosarcoma Bronchopleural fistula |
Others | Esophagopleural fistula |