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Background <p>Traumatic pneumothorax is a common finding in blunt thoracic trauma, yet its intrathoracic distribution has not been systematically characterized. A clearer understanding of CT-based distribution patterns may provide clinically relevant anatomical context for trauma assessment and targeted imaging in the emergency department.</p> Methods <p>We conducted a retrospective cohort study of adult patients with blunt thoracic trauma and pneumothorax confirmed on chest computed tomography (CT) between January 2021 and February 2025. Pneumothorax volume was quantified using three-dimensional CT segmentation and categorized into five volume strata (0–200, 200–400, 400–600, 600–800, and ≥ 800 mL). Each hemithorax was divided into seven predefined CT-based anatomical regions using a standardized medial–lateral and vertical tiered framework. Regional involvement was analyzed across volume categories, and logistic regression was performed to evaluate medial versus lateral distribution patterns.</p> Results <p>Ninety pneumothoraces from 85 patients were included. The lower parasternal, middle parasternal, and lower lateral regions were the most frequently involved, including in small-volume pneumothoraces. In contrast, supraclavicular, upper parasternal, upper lateral, and middle lateral regions demonstrated progressively greater involvement with increasing pneumothorax volume. Medial regions were significantly more likely to be involved than lateral regions (odds ratio approximately 1.8–1.9, <i>p</i> &lt; 0.01). Overall, pneumothorax extension followed a reproducible pattern progressing from anteromedial and inferior regions toward superior and lateral regions as volume increased.</p> Conclusion <p>Traumatic pneumothorax demonstrates consistent, volume-dependent anatomical distribution patterns on chest CT in adult blunt trauma patients. These findings provide clinically relevant insight into pleural air redistribution and may help refine imaging-based detection strategies and improve early recognition of pneumothorax in supine trauma patients in the emergency setting.</p>

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CT distribution patterns of traumatic pneumothorax in blunt thoracic trauma: implications for targeted emergency imaging

  • 期刊论文

  • 发表日期：

    2026年4月22日

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  • Latife Jabbari,
  • Jaleh Dashtian,
  • Leila Azizkhani,
  • Saeed Hayati

摘要

Background

Traumatic pneumothorax is a common finding in blunt thoracic trauma, yet its intrathoracic distribution has not been systematically characterized. A clearer understanding of CT-based distribution patterns may provide clinically relevant anatomical context for trauma assessment and targeted imaging in the emergency department.

Methods

We conducted a retrospective cohort study of adult patients with blunt thoracic trauma and pneumothorax confirmed on chest computed tomography (CT) between January 2021 and February 2025. Pneumothorax volume was quantified using three-dimensional CT segmentation and categorized into five volume strata (0–200, 200–400, 400–600, 600–800, and ≥ 800 mL). Each hemithorax was divided into seven predefined CT-based anatomical regions using a standardized medial–lateral and vertical tiered framework. Regional involvement was analyzed across volume categories, and logistic regression was performed to evaluate medial versus lateral distribution patterns.

Results

Ninety pneumothoraces from 85 patients were included. The lower parasternal, middle parasternal, and lower lateral regions were the most frequently involved, including in small-volume pneumothoraces. In contrast, supraclavicular, upper parasternal, upper lateral, and middle lateral regions demonstrated progressively greater involvement with increasing pneumothorax volume. Medial regions were significantly more likely to be involved than lateral regions (odds ratio approximately 1.8–1.9, p < 0.01). Overall, pneumothorax extension followed a reproducible pattern progressing from anteromedial and inferior regions toward superior and lateral regions as volume increased.

Conclusion

Traumatic pneumothorax demonstrates consistent, volume-dependent anatomical distribution patterns on chest CT in adult blunt trauma patients. These findings provide clinically relevant insight into pleural air redistribution and may help refine imaging-based detection strategies and improve early recognition of pneumothorax in supine trauma patients in the emergency setting.