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Journal of the Korean Society of Traumatology 2003;16(1):58-63.
Treatment of Occult Pneumothoraces according to Computed Tomog raphic Scan Classification
Jin Seong Cho, M.D., Yong Su Lim, M.D., Gun Lee, M.D., Seung Youl Hyun, M.D.*, Wook Jin, M.D.**, Seong Youn Hwang, M.D.***
Department of Emergency Medicine, Thoracic and Cardiovascular Surgery*
Diagnostic Radiology** Ghil Medical Center, Gachon Medical School, Incheon, Korea, Department of Emergency Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea***
둔상에 의해 발생한 잠복기흉의 치료방침 (컴퓨터 단층 촬영 소견에 의한 분류)
가천의과대학교 길병원 응급의학과, 흉부외과*
성균관대학교 의과대학 마산삼성병원 응급의학과***
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.
Key Words: Occult pneumothroax; Computed tomography; Tube thoracostomy
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