Pneumothorax (traumatic)

[Tariq Zaki]

Traumatic pneumothorax is air in the pleural space resulting from trauma and causing partial or complete lung collapse. Symptoms include chest pain from the causative injury and sometimes dyspnea. Diagnosis is made by chest x-ray. Treatment is usually with tube thoracostomy.
(See also Overview of Thoracic Trauma.)
Spontaneous pneumothorax is discussed elsewhere.
Pneumothorax can be caused by penetrating or blunt trauma; many patients also have a hemothorax (hemopneumothorax). In patients with penetrating wounds that traverse the mediastinum (eg, wounds medial to the nipples or to the scapulae), or with severe blunt trauma, pneumothorax may be caused by disruption of the tracheobronchial tree. Air from the pneumothorax may enter the soft tissues of the chest and/or neck (subcutaneous emphysema), or mediastinum (pneumomediastinum).
A simple unilateral pneumothorax, even when large, is well tolerated by most patients unless they have significant underlying pulmonary disease. However, tension pneumothorax can cause severe hypotension, and open pneumothorax can compromise ventilation.