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Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report

INTRODUCTION: Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pne...

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Autores principales: Idris, Baig M., Hefny, Ashraf F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885144/
https://www.ncbi.nlm.nih.gov/pubmed/27232292
http://dx.doi.org/10.1016/j.ijscr.2016.05.019
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author Idris, Baig M.
Hefny, Ashraf F.
author_facet Idris, Baig M.
Hefny, Ashraf F.
author_sort Idris, Baig M.
collection PubMed
description INTRODUCTION: Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. PRESENTATION OF CASE: A 63- year- old man presented to the Emergency Department complaining of left lateral chest pain due to a fall on his chest at home. On examination, he was hemodynamically stable. An urgent chest X-ray showed evidence of left sided pneumothorax. CT scan of the chest showed pneumothorax of more than 30% of the left hemithorax (around 600 ml of air) with multiple left ribs fracture. Patient refused tube thoracostomy and was admitted to surgical department for close observation. The patient was managed conservatively without chest tube insertion. A repeat CT scan of the chest has shown complete resolution of the pneumothorax. DISCUSSION: The clinical spectrum of pneumothorax varies from asymptomatic to life threatening tension pneumothorax. In stable patients, conservative management can be safe and effective for small pneumothorax. To the best of our knowledge, this is the second reported case in the English literature with large pneumothorax which resolved spontaneously without chest drain. CONCLUSION: Blunt traumatic large pneumothorax in a clinically stable patient can be managed conservatively. Current recommendations for tube placement may need to be reevaluated. This may reduce morbidity associated with chest tube thoracostomy.
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spelling pubmed-48851442016-06-07 Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report Idris, Baig M. Hefny, Ashraf F. Int J Surg Case Rep Case Report INTRODUCTION: Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. PRESENTATION OF CASE: A 63- year- old man presented to the Emergency Department complaining of left lateral chest pain due to a fall on his chest at home. On examination, he was hemodynamically stable. An urgent chest X-ray showed evidence of left sided pneumothorax. CT scan of the chest showed pneumothorax of more than 30% of the left hemithorax (around 600 ml of air) with multiple left ribs fracture. Patient refused tube thoracostomy and was admitted to surgical department for close observation. The patient was managed conservatively without chest tube insertion. A repeat CT scan of the chest has shown complete resolution of the pneumothorax. DISCUSSION: The clinical spectrum of pneumothorax varies from asymptomatic to life threatening tension pneumothorax. In stable patients, conservative management can be safe and effective for small pneumothorax. To the best of our knowledge, this is the second reported case in the English literature with large pneumothorax which resolved spontaneously without chest drain. CONCLUSION: Blunt traumatic large pneumothorax in a clinically stable patient can be managed conservatively. Current recommendations for tube placement may need to be reevaluated. This may reduce morbidity associated with chest tube thoracostomy. Elsevier 2016-05-19 /pmc/articles/PMC4885144/ /pubmed/27232292 http://dx.doi.org/10.1016/j.ijscr.2016.05.019 Text en © 2016 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Idris, Baig M.
Hefny, Ashraf F.
Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report
title Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report
title_full Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report
title_fullStr Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report
title_full_unstemmed Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report
title_short Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report
title_sort large pneumothorax in blunt chest trauma: is a chest drain always necessary in stable patients? a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885144/
https://www.ncbi.nlm.nih.gov/pubmed/27232292
http://dx.doi.org/10.1016/j.ijscr.2016.05.019
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