Conservative management of pneumothorax due to chest trauma

The aim of this study is to assess the safe- ty of conservative management modalities in patients with traumatic pneumothorax (PTX). Materials and Methods: We retrospectively ana- lyzed the records of 128 patients with the diagnosis of PTX and hemopneumothorax (HPTX) due to chest trauma between 2002 and 2007. The mecha- nism of trauma, the treatment modality, the size of PTX (we define small PTX less than 20% of tho- racic volume) pulmonary and extra pulmonary injuries, and the number of rib fractures were ana- lyzed. Results: There were 97 male and 31 female trauma patients whose age ranged from 16 to 77. The mechanism of injury was blunt trauma in 60 patients and penetrating trauma in 68 patients. Pulmonary complications were PTX in 71, hemop- neumothorax (HPTX) in 57 patients. Forty seven patients with chest trauma had associated rib frac- tures .Thirty three (25.8%) injuries were treated initially without chest tube drainage. Four of these 33 patients subsequently had chest drain applica- tion because of asymptomatic enlargement of the pneumothorax size on chest radiography during the follow up period. None of the remaining 29 patients deteriorated clinically during conservative treatment. Conclusions: This study demonstrates that most traumatic small PTX can be safely managed with- out the surgical approach of chest tube drainage.