At what interval should patients be monitored following diagnosis of a 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

No protocols regarding serial radiography or imaging exist; the clinician typically reviews serial vital signs and clinical assessments, using the direction and rate of change in the patient’s clinical status to select imaging frequency. Monitoring pneumothorax size during this time is important, as follows:

  • At 0-6 hours - The ACCP Delphi consensus statement recommends observation in an ED for 6 hours, and discharge to home if a follow-up chest radiograph shows no enlargement of the lesion, in reliable patients [39] ; ED observation with a repeat radiograph 6 hours later used to be common but may be used less often now
  • At 24-96 hours - Additional follow up in 2 days is recommended, with preference given to a 24-48 hour follow-up radiograph in the outpatient setting; outpatient follow-up during the 96-hour window is essential to distinguish between a resolved pneumothorax and one that needs evacuation; CT at this time distinguishes between PSP and secondary spontaneous pneumothorax (SSP)
  • At 1 month - Full lung reexpansion can occur, on average, 3 weeks after the initial event

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