Management of minimal pneumothorax in penetrating chest trauma - Is observation safe?

Q: How were minimal and large pneumothorax cases defined in the study?

Patients were classified by CT findings into minimal pneumothorax (MP, ≤2 cm) and large pneumothorax (LP, >2 cm) based on the maximal pleural gap between the visceral pleura and chest wall.

Sep 30, 2026

Uploaded by anakgang17

Traumatic pneumothorax is a frequent chest-trauma finding that forces rapid decisions between tube thoracostomy and observation. This study analyzed 193 consecutive penetrating thoracic trauma patients over 2020–2025, classifying minimal versus large pneumothorax using CT measurements. Conservative observation succeeded in 90.2% of minimal cases, while large pneumothoraces required chest tubes in 95.1%, with longer stays, more ICU admissions, higher ISS, and more complications. Mortality occurred only in the chest tube group.

LanguageEnglish

CategoryHealthcare

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Abstract

Background

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Materials and Methods

ORIGINAL ARTICLE Management of minimal pneumothorax in penetrating chest trauma: Is observation safe? Salih Duman,1 Rassim Kassim,1 Eren Erdogdu,1 Leman Damla Ercan,2 Ali Fuat Kaan Gök,2 Berker Özkan,1 Mehmet İlhan,2 Murat Kara,1 Cemalettin Ertekin2 1Department of Thoracic Surgery, Istanbul University Faculty of Medicine, İstanbul-Türkiye 2Department of General Surgery, Istanbul University Faculty of Medicine, İstanbul-Türkiye ABSTRACT BACKGROUND: Traumatic pneumothorax is one of the most common findings encountered after chest trauma and often forces clinicians to quickly decide between tube thoracostomy and observation. Although large pneumothoraces (LP), most often defined radiologically as a pleural gap greater than 2 cm, are routinely managed with chest tube drainage, the management of minimal pneumothoraces (MP) is still a matter of debate. METHODS: In this study, we analyzed 193 consecutive penetrating thoracic trauma patients managed in our center over a five-year period (2020–2025). Patients were classified into minimal pneumothorax and large pneumothorax groups based on computed tomography (CT) findings. Clinical and radiological parameters, Injury Severity Score (ISS), complications, and hospital stay were recorded, and their associations with chest tube placement were assessed. RESULTS: Among the 193 patients, 112 (58%) were in the MP group and 81 (42%) in the LP group. The median age was comparable between groups (30.5 years [interquartile range, IQR: 22.8-39.3] vs. 28 years [IQR: 23-39], p=0.797). Gender distribution was also similar, with males accounting for 93.3% in the MP group and 93.8% in the LP group (p=1.000). Pneumothorax size strongly influenced treatment (p<0.001): chest tube thoracostomy was performed in 95.1% of LP vs. 9.8% of MP cases. Conservative observation was successful in 90.2% of MP patients. LP patients had significantly longer hospital stays (8.29 vs. 4.56 days, p<0.001), higher ICU admission rates (27.2% vs. 5.4%, p<0.001), and higher ISS (21.33 vs. 13.68, p<0.001). Complications were more frequent in LP (24.7% vs. 0.9%, p<0.001), with hemothorax, persistent air leak, and pleural effusion being the most common. Most hemothorax cases were attributed to the initial penetrating trauma, while only a small minority were tube-related. Among patients with LP (>2 cm), four were managed conservatively due to their stable clinical condition, and no mortality occurred in this subgroup. Mortality occurred exclusively in the chest tube group (18/88, 20.5%), with no deaths among observed patients overall (p<0.001). In subgroup analysis, gunshot wounds were associated with a higher need for chest tube even in MP (20.7% vs. 6.0%, p=0.033). CONCLUSION: Our findings indicate that careful observation is a safe option in patients with minimal pneumothoraces, while large pneumothoraces generally necessitate invasive treatment and are associated with worse outcomes. Our results are consistent with previous reports in the international literature. Keywords: Conservative management; Injury Severity Score (ISS); Penetrating thoracic trauma; traumatic pneumothorax; tube thoracostomy. Cite this article as: Duman S, Kassim R, Erdogdu E, Ercan LD, GökAFK, Özkan B, et al. Management of minimal pneumothorax in penetrating chest trauma: Is observation safe?. Ulus Travma Acil Cerrahi Derg 2025;31:966-970. Address for correspondence: Salih Duman Department of Thoracic Surgery, Istanbul University Faculty of Medicine, İstanbul, Türkiye E-mail: [dr.salihduman@hotmail.com](dr.salihduman@hotmail.com) Ulus Travma Acil Cerrahi Derg 2025;31(10):966-970 DOI: 10.14744/tjtes.2025.40552 Submitted: 05.09.2025 Revised: 16.09.2025 Accepted: 19.09.2025 Published: 07.10.2025 OPEN ACCESS This is an open access article under the CC BY-NC license ([http://creativecommons.org/licenses/by-nc/4.0/](http://creativecommons.org/licenses/by-nc/4.0/)). 966 Ulus Travma Acil Cerrahi Derg, October 2025, Vo

FAQs

How were minimal and large pneumothorax cases defined in the study?

Patients were classified by CT findings into minimal pneumothorax (MP, ≤2 cm) and large pneumothorax (LP, >2 cm) based on the maximal pleural gap between the visceral pleura and chest wall.

What proportion of minimal pneumothorax patients were successfully managed with observation?

Conservative observation was successful in 90.2% of MP patients.

Did mortality differ between observed and chest tube patients?

Mortality occurred exclusively in the chest tube group (20.5% overall for that group), with no deaths among observed patients overall.

Sep 30, 2026

Uploaded by anakgang17