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This review article answers the basic question: when does a traumatic pneumothorax require tube thoracostomy?
“A pneumothorax greater than 20% of the thoracic volume on chest x-ray or greater than 35 mm on CT, measured radially from the chest wall to the lung parenchyma, should be treated with tube thoracostomy. Pneumothoraces smaller than this may be observed; approximately 10% of these will fail observation and require tube thoracostomy treatment.”
References
Blank JJ, de Moya MA. Traumatic pneumothorax and hemothorax: What you need to know. J Trauma Acute Care Surg. 2025 Jul 3. doi: 10.1097/TA.0000000000004692. Epub ahead of print. PMID: 40604368.