Sunday, 24 November 2013

Pleural disease – Pneumothorax – The Diagnosis

The pleura is a thin tissue covered by a layer of cells (mesothelial cells) that surrounds the lungs and lines the inside of the chest wall.
A. Pneumothorax is defined as a condition of collection of air within the pleural cavity, from either the outside or from the lung of which affect the lung breathing.
D.2. Diagnosis
If you are experience some symptoms above, after recording the family history and the complete physical examination, the tests which you doctor orders include
1. X ray
In most case, pneumothorax can be detected by X ray as the image of pneumothorax as thoracic cavity is partly filled with air occupying the pleural space. If the X-ray does not show a pneumothorax but your doctoe strong suspicion of one, lateral X-rays (with beams projecting from the side) may be performed. There is a report of Two medicolegal cases involvin chest X-ray with left-and-right side confusion due to lack of radio-opaque side markers(43).
2. Ultrasound
Ultrasound (US) is a sensitive diagnostic tool for detecting pneumothorax (PTX). According to the study by Norwegian Air Ambulance Foundation, in the study to define the distribution of air using the reference imaging standard computed tomography (CT), to see if pleural insufflation of air into a live anaesthetized pig truly imitates a PTX in an injured patient, indicated that the distribution of the intrathoracic air to be similar between a porcine model and that to be expected in human trauma patients, all having predominantly anterior PTX topographies. In a training facility, the model is easy to set up and can be scanned by the participants multiple times. To acquire the necessary skills to perform thoracic US examinations for PTX, the porcine models could be useful(44).
3. CT scan
There is a reprot of 3 cases which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that “occult pneumothorax is predictable(45).
Other study in the aetiological diagnosis and subsequent management of patients with primary spontaneous pneumothorax, found that in 75% of these cases, CT revealed underlying lung pathology as a cause for primary spontaneous pneumothorax(46).
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