Diagnosis of pneumothorax in critically ill adults

The diagnosis of pneumothorax is established from the patients' history, ph ysical examination and, where possible, by radiological investigations. Adu lt respiratory distress syndrome, pneumonia, and trauma are important predi ctors of pneumothorax, as are various practical procedures including mechan ical ventilation, central line insertion, and surgical procedures in the th orax, head, and neck and abdomen. Examination should include an inspection of the ventilator observations and chest drainage systems as well as the pa tients cardiovascular and respiratory systems. Radiological diagnosis is no rmally confined to plain frontal radiographs in the critically ill patient, although lateral images and computed tomography are also important. Situat ions are described where an abnormal lucency or an apparent lung edge may b e confused with a pneumothorax. These may arise from outside the thoracic c avity or from lung abnormalities or abdominal viscera inside the chest.