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Pneumothorax following procedure — Clinical Guidelines

Overview

Pneumothorax is a potential complication following interventional radiological procedures, characterized by the presence of air in the pleural space leading to lung collapse or compression 1 10.

Diagnosis

Clinical signs include sudden chest pain, dyspnea, and decreased breath sounds on the affected side 1.

Diagnostic imaging, particularly chest X-ray, is essential for confirming the presence of pneumothorax 1 10.

Grading systems like the size of pneumothorax on imaging can help in assessing severity 10.

Management

Small pneumothoraces may resolve spontaneously and require close monitoring 1.

Larger pneumothoraces or those causing significant symptoms may require needle aspiration or chest tube insertion 1 10.

Oxygen therapy is often used to manage symptoms and promote resorption 1.

Special Populations

Pediatrics: Specific considerations for sedation and procedural risks are noted, though direct management specifics for pneumothorax post-procedure are not detailed 4 8.

Elderly: No specific guidelines provided in the abstracts regarding unique management needs for elderly patients 10.

Comorbidities: Management may need adjustment based on underlying conditions, though specific recommendations are not provided 10.

Key Recommendations

Monitor patients closely post-procedure for signs of pneumothorax, particularly in high-risk interventions 1.

Utilize imaging (chest X-ray) for definitive diagnosis of pneumothorax 1 10.

Implement needle aspiration or chest tube insertion for symptomatic or large pneumothoraces 1 10.

(Evidence: Moderate)

References

1 Morcillo AB, Huerga C, Bayón J, López A, Corredoira E, Hernández T et al.. ASSESSMENT OF OCCUPATIONAL EXPOSURE IN THE MAIN PAEDIATRIC INTERVENTIONAL RADIOLOGY PROCEDURES. Radiation protection dosimetry 2022. link 2 Planz V, Huang J, Galgano SJ, Brook OR, Fananapazir G. Variability in personal protective equipment in cross-sectional interventional abdominal radiology practices. Abdominal radiology (New York) 2022. link 3 Compagnone G, Padovani R, D'Ercole L, Orlacchio A, Bernardi G, D'Avanzo MA et al.. Provision of Italian diagnostic reference levels for diagnostic and interventional radiology. La Radiologia medica 2021. link 4 Li B, Zhang R, Huang Y, Zhang K, Wat CY, Bai J et al.. Moderate and deep sedation for non-invasive paediatric procedures in tertiary maternity and children's hospitals in China: a questionnaire survey from China. BMC health services research 2020. link 5 Picard M, Nelson R, Roebel J, Collins H, Anderson MB. Use of Low-Fidelity Simulation Laboratory Training for Teaching Radiology Residents CT-Guided Procedures. Journal of the American College of Radiology : JACR 2016. link 6 Vano E, Ten JI, Fernandez-Soto JM, Sanchez-Casanueva RM. Experience with patient dosimetry and quality control online for diagnostic and interventional radiology using DICOM services. AJR. American journal of roentgenology 2013. link 7 Lee RK, Chu WC, Graham CA, Rainer TH, Ahuja AT. Knowledge of radiation exposure in common radiological investigations: a comparison between radiologists and non-radiologists. Emergency medicine journal : EMJ 2012. link 8 Ryan G, Treston G. Do family members interfere in the delivery of care when present during invasive paediatric procedures in the emergency department?. Emergency medicine Australasia : EMA 2007. link 9 Mayson K, Lennox P, Anserimo M, Forster BB. Canadian radiology residents' knowledge of sedation and analgesia: a web-based survey. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes 2006. link 10 Filippova I. Patient and staff doses in radiology and cardiology in Estonia. Radiation protection dosimetry 2005. link 11 Verdun FR, Aroua A, Trueb PR, Vock P, Valley JF. Diagnostic and interventional radiology: a strategy to introduce reference dose level taking into account the national practice. Radiation protection dosimetry 2005. link 12 Ng KC, Ang SY. Sedation with ketamine for paediatric procedures in the emergency department--a review of 500 cases. Singapore medical journal 2002. link 13 Zoetelief J, Faulkner K. Equipment requirements and specification for digital and interventional radiology. Radiation protection dosimetry 2001. link

Pneumothorax following procedure