What is the role of a chest CT scan in the evaluation of pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

Chest CT is the most reliable imaging study for the diagnosis of pneumothorax, but it is not recommended for routine use in pneumothorax. This imaging modality can help to accomplish the following:

  • Distinguish between a large bulla and a pneumothorax
  • Indicate underlying emphysema or emphysemalike changes (ELCs)
  • Determine the exact size of the pneumothorax, especially if it is small
  • Confirm the diagnosis of pneumothorax in patients with head trauma who are mechanically ventilated
  • Detect occult/small pneumothoraces and pneumomediastinum (although the clinical significance of these occult pneumothoraces is unclear, particularly in the stable nonintubated patient)

CT is widely used in actual clinical practice to assess the possibility of associated concurrent pulmonary disease because of the inherent superiority of CT for visualizing the details of lung parenchyma and pleura (see the images below).

Computed tomography scan demonstrating blebs in a Computed tomography scan demonstrating blebs in a patient with chronic obstructive pulmonary disease (COPD).
Computed tomography scan demonstrating a bulla in Computed tomography scan demonstrating a bulla in an asymptomatic patient.
Computed tomography scan demonstrating secondary s Computed tomography scan demonstrating secondary spontaneous pneumothorax (SSP) from radiation/chemotherapy for lymphoma.
Computed tomography scan demonstrating emphysemato Computed tomography scan demonstrating emphysematouslike changes (ELCs) in a patient with chronic obstructive pulmonary disease (COPD).
Computed tomography scan in a patient with a histo Computed tomography scan in a patient with a history of bilateral pleurodesis and a strong family history of spontaneous pneumothorax.

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