Size of PTX

Q: While evaluating pneumothorax (PTX) on Chest-X-Ray (CXR), a distance of ≥3 cm between the pleural line and the chest wall at the level of the apex roughly correlates with a 50 percent pneumothorax.

A) True

B) False

Answer: A

Although not an exact science, at least in the United States, PTX ≥3 cm between the pleural line and the chest wall at the level of the apex is usually considered sufficient to distinguish a small from a large PTX. In Europe, physicians use a cutoff of ≥2 cm at the hilum. 

Clinical symptoms play a significant role in draining PTX and largely depend on the clinician's discretion.

#procedures

References:

1. Roberts ME, Rahman NM, Maskell NA, et al. British Thoracic Society Guideline for pleural disease. Thorax 2023; 78:1143.

2. Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001; 119:590.

3. MacDuff A, Arnold A, Harvey J, BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65 Suppl 2:ii18.

4. Bintcliffe OJ, Hallifax RJ, Edey A, et al. Spontaneous pneumothorax: time to rethink management? Lancet Respir Med 2015; 3:578.

5. Yoon J, Sivakumar P, O'Kane K, Ahmed L. A need to reconsider guidelines on management of primary spontaneous pneumothorax? Int J Emerg Med 2017; 10:9.