Idris Baig M, Hefny Ashraf F
Department of Emergency Medicine Al Rahba Hospital, Abu Dhabi, United Arab Emirates.
Department of Surgery, Al Rahba Hospital, Abu Dhabi, United Arab Emirates.
Int J Surg Case Rep. 2016;24:88-90. doi: 10.1016/j.ijscr.2016.05.019. Epub 2016 May 19.
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.
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 600ml 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.
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.
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.
气胸是最常见的潜在危及生命的钝性胸部损伤。气胸的治疗取决于病因、气胸大小以及患者的血流动力学稳定性。大多数临床医生都认为胸腔闭式引流对于创伤性大量气胸的治疗至关重要。在此，我们报告一例钝性胸部创伤患者发生大量气胸，未经胸腔闭式引流而自行吸收的病例。
一名63岁男性因在家中胸部着地摔倒后出现左侧胸痛而就诊于急诊科。检查发现，他的血流动力学稳定。急诊胸部X线检查显示左侧气胸。胸部CT扫描显示左侧气胸超过左半胸的30%（约600ml气体），伴有多根左侧肋骨骨折。患者拒绝行胸腔闭式引流术，被收入外科密切观察。患者接受保守治疗，未插入胸腔引流管。胸部CT复查显示气胸已完全吸收。
气胸的临床症状从无症状到危及生命的张力性气胸不等。对于病情稳定的患者，保守治疗对于小量气胸可能是安全有效的。据我们所知，这是英文文献中第二例报道的大量气胸未经胸腔闭式引流而自行吸收的病例。
临床症状稳定的钝性创伤性大量气胸患者可以采用保守治疗。目前关于放置胸腔引流管的建议可能需要重新评估。这可能会降低与胸腔闭式引流术相关的发病率。
