Pneumothorax refers to the presence of air in the
pleural cavity between the visceral and parietal
Pneumothorax represents the most commonly
occurring air leak.
it occurs spontaneously in 1 to 2 percent of term
neonates without pulmonary disease.
The rate of occurrence increases in ventilated
neonates, where it ranges from 20 to 30 percent.
Various mechanisms have been thought to be
responsible for producing air leaks
Pneumothorax is generally a clinical diagnosis
that is confirmed with plain radiography and or
Transillumination of the chest .
• 1. Increased lucency on the affected side.
• 2. Decreased or absent pulmonary vascular
• 3. Overall increase in the size of the affected
• 4. Widened intercostal spaces.
• 5. Flattened diaphragm on the affected side.
• 6. Sharp edge sign. The cardiac border and the
diaphragm are seen in sharp contrast.
X-Ray Findings cont.
• 7. With tension pneumothorax,
mediastinal shift with deviation of the
trachea and heart to the opposite
• Decreased volume and increased
opacity of the opposite lung.
• 8. With bilateral pneumothoraces,
narrow cardiac silhouette.
• A 27-week gestation, 1,000 gm female
born to a 19-year-old, Primi unbooked.
The mother came to the emergency
room complaining of increasingly
severe abdominal cramping over the
past six hours. On physical
examination, labor were suspected,
and the neonate delivered precipitously
before any further testing could be
done. Emergency room personnel
provided 100 percent oxygen and bag
and mask ventilation, called for
pediatrician, patient intubated then
transfered to NICU.
• A right tension pneumothorax
• The shadow of the atelectatic
right lung is visible.
• The heart and the
mediastinum are shifted to the
• Decompression of the right
chest is required.
• Always review all old films to properly
assess the new one. Subtle findings
can easily be missed when a single
previous examination is reviewed.
• Obtaining a lateral x-ray can help to
define the site and extent of the
• High index of suspicion is necessary
for diagnosis of pnuemothorax.
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