eMedicine Specialties > Thoracic Surgery > Trauma

Pneumothorax: Follow-up

Author: Rebecca Bascom, MD, MPH, Professor of Medicine, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Pennsylvania State College of Medicine, Milton S Hershey Medical Center; Graduate Faculty Member, Pennsylvania State University College of Medicine and The Huck Institutes of the Life Sciences
Coauthor(s): Michael G Benninghoff, MS, DO, Fellow in Pulmonary and Critical Care Medicine, Penn State Hershey Medical Center; Shoaib Alam, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, Pennsylvania State University and Hershey Medical Center
Contributor Information and Disclosures

Updated: Feb 10, 2009

Follow-up

Further Outpatient Care

  • Patients should receive follow-up care from a pulmonary physician within 7-10 days.

Deterrence/Prevention

  • Patients should not travel by air or travel to remote sites until radiography shows complete resolution.
  • Patients cannot smoke. They should be assessed as to readiness to quit, educated about smoking cessation, and provided with pharmacotherapy if ready to quit. Direct patients indicating a readiness to quit smoking to their primary care physician or offer referral for cessation management. This may include nicotine replacement and non-nicotine pharmacotherapy such as bupropion or varenicline.

Complications

  • Respiratory or cardiac arrest
  • Hemopneumothorax
  • Bronchopulmonary fistula
  • Pain at the site of chest tube insertion, infection, and hemorrhage

Prognosis

  • Complete resolution of uncomplicated pneumothorax takes approximately 10 days.
  • The recurrence rate of primary spontaneous pneumothorax (PSP) is 32%. The presence of emphysematouslike changes in PSP has no predictive value for the future development of recurrence.
  • Age is a predictor of recurrence.
  • Contralateral recurrence of PSP: A retrospective study of 231 patients with PSP showed that 33 (14%) had a contralateral recurrence.8 Low BMI was deemed a risk factor for contralateral recurrence on univariate and multiple logistic regression analysis. Contralateral blebs were seen by CT in higher frequency in the patients with contralateral recurrence than those without a contralateral recurrence. In this series, all patients with contralateral recurrence were treated surgically.8

Patient Education

  • Smoking cessation

Miscellaneous

Medicolegal Pitfalls

  • Imaging studies should not delay the diagnosis of tension pneumothorax. Tension pneumothorax is a medical emergency and requires immediate treatment.
  • Chest radiographs may fail to reveal pneumothorax. Radiologists or emergency physicians may fail to recognize the presence of the pneumothorax. A vertical skin line can be mistaken for a pneumothorax, leading to unnecessary and possibly harmful therapy.
  • Expiratory chest radiographs do not improve detection of pneumothorax after procedures with the potential to cause a pneumothorax.
  • A high index of suspicion for tension pneumothorax is recommended in patients on mechanical ventilation with acute onset of hemodynamic instability, difficult ventilation with high inspiratory pressures, and worsening hypoxemia and/or hypercapnia, even with a functioning chest tube in place. Portable chest radiograph may fail to show the pneumothorax; CT may be required for diagnosis.
  • Always consider pneumothorax in the differential diagnosis of major trauma.
  • Spontaneous pneumothorax is a life-threatening condition in patients with severe underlying lung disease.
  • CT scan of the chest is the most reliable imaging study for the diagnosis of pneumothorax.
 
Acknowledgments

The authors wish to acknowledge the contributions of Milos Tucakovic, MD; Seema Jain, MD; and Tunc Iyriboz, MD to previous versions of this chapter.



More on Pneumothorax

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Treatment & Medication: Pneumothorax
Follow-up: Pneumothorax
Multimedia: Pneumothorax
References
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Further Reading

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Keywords

pneumothorax, primary spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP), iatrogenic pneumothorax, traumatic pneumothorax, parenchymal lung disease, apical pleural blebs, chronic obstructive pulmonary disease, COPD, Pneumocystis jiroveci pneumonia, PCP, hemopneumothorax, bronchopleural fistula, transthoracic needle aspiration, therapeutic thoracentesis, pleural biopsy, central venous catheter insertion, transbronchial biopsy, positive pressure mechanical ventilation, inadvertent intubation of the right mainstem bronchus, diagnostic ultrasound

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Contributor Information and Disclosures

Author

Rebecca Bascom, MD, MPH, Professor of Medicine, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Pennsylvania State College of Medicine, Milton S Hershey Medical Center; Graduate Faculty Member, Pennsylvania State University College of Medicine and The Huck Institutes of the Life Sciences
Rebecca Bascom, MD, MPH is a member of the following medical societies: American College of Chest Physicians, American Public Health Association, American Thoracic Society, and Pennsylvania Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Michael G Benninghoff, MS, DO, Fellow in Pulmonary and Critical Care Medicine, Penn State Hershey Medical Center
Michael G Benninghoff, MS, DO is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Osteopathic Association, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Shoaib Alam, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, Pennsylvania State University and Hershey Medical Center
Shoaib Alam, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, European Respiratory Society, International Society for Magnetic Resonance in Medicine, Pennsylvania Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Benson B Roe, MD, Emeritus Chief, Division of Cardiothoracic Surgery, Emeritus Professor, Department of Surgery, University of California at San Francisco Medical Center
Benson B Roe, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American College of Cardiology, American College of Surgeons, American Heart Association, American Medical Association, American Society for Artificial Internal Organs, American Surgical Association, California Medical Association, Society for Vascular Surgery, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Daniel S Schwartz, MD, FACS, Assistant Clinical Professor of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Thoracic Surgery, Huntington Hospital
Daniel S Schwartz, MD, FACS is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, Society of Thoracic Surgeons, and Western Thoracic Surgical Association
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association
Disclosure: Nothing to disclose.

 
 
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