CXR in PTX

Q: Which phase of respiration on CXR is better to detect pneumothorax (PTX)? (select one)

A) inspiration 

B) expiration 

Answer: B

Inspiration or expiration doesn't affect the volume of air in the pleural space and pneumothorax can be detected better in expiration with less air volume in lung parenchyma, visually magnifying the air in the pleural area.

Said that controversy continues to exist in literature - but the overall literature leans towards doing CXR  in expiration to detect PTX. With the availability of instant digital CXR at the bedside, it may be of value to perform CXR in succession with inspiration followed by  expiration.

#radiology

#pulmonary

References:

1. Thomsen L, Natho O, Feigen U, Schulz U, Kivelitz D. Value of digital radiography in expiration in detection of pneumothorax. Rofo. 2014 Mar;186(3):267-73. doi: 10.1055/s-0033-1350566. Epub 2013 Sep 16. PMID: 24043613.

2. Galanski M, Hartenauer U, Krumme B. Röntgendiagnostik des Pneumothorax auf Intensivstationen [X-Ray diagnosis of pneumothorax in intensive care units (author's transl)]. Radiologe. 1981 Oct;21(10):459-62. German. PMID: 7302201.

3. Cases Susarte I, Sánchez González A, Plasencia Martínez JM. Should we perform an inspiratory or an expiratory chest radiograph for the initial diagnosis of pneumothorax? Radiologia (Engl Ed). 2018 Sep-Oct;60(5):437-440. English, Spanish. doi: 10.1016/j.rx.2017.10.004. Epub 2017 Dec 6. PMID: 29208316.