Management of Pneumothorax or Hemothorax Detected on CT but Not X-Ray

Treatment recommendations for hemothorax and pneumothorax were codified when most of these injuries were identified with plain films. However, increased use of computed tomography (CT) allows detection of smaller injuries, raising the question of which injuries require chest tube drainage.

These authors performed a secondary analysis of two observational NEXUS Chest cohorts to determine current treatment practices for pneumothoraces and hemothoraces detected by CT but not by plain films. Enrolled patients were older than 14 years; presented to one of 10 urban, U.S. level 1 trauma centers within 6 hours of blunt trauma; and underwent chest CT or x-ray. Among 21,382 enrolled patients, 1064 (5%) had pneumothorax and 384 (2%) had hemothorax.

Nine…