Treatment of occult pneumothoraces from blunt trauma

Background: Occult pneumothoraces (OPTXs) are seen on abdominal computed to mographic (CT) scans but not on routine chest x-ray films. Optimal treatmen t for blunt trauma OPTXs has not been defined. We hypothesized that OPTXs c ould be safely observed without need for a chest tube (CT), Methods: A prospective trial randomized blunt trauma patients with OPTXs to CT scan or observation. Patients were not excluded for positive pressure v entilation. Primary outcome measures were respiratory distress and pneumoth oraces progression. Results: Thirty-nine patients with 44 pneumothoraces were enrolled, Eightee n patients received a CT scan, and 21 patients were observed, Nine patients in each group received positive pressure ventilation. There was no differe nce in overall complication rate. No patient had respiratory distress relat ed to the OPTX or required emergent CT scan. Conclusions: Observation of OPTX is not associated with an increased incide nce of pneumothorax progression or respiratory distress. These pneumothorac es can be safely observed in patients with blunt trauma injury regardless o f the need for positive pressure ventilation.