• Chad G Ball, Andrew W Kirkpatrick, Kevin B Laupland, Dan L Fox, Stacey Litvinchuk, Dianne M M Dyer, Ian B Anderson, S Morad Hameed, John B Kortbeek, and Rob Mulloy.
• Department of Surgery, Foothills Medical Centre, Room EG23, 1403-29 Street NW, Calgary, Alberta, Canada.
• Am. J. Surg. 2005 May 1;189(5):541-6; discussion 546.

PurposeAlthough posttraumatic pneumothoraces (PTXs) are common and potentially life threatening, the supine chest radiograph (CXR) is an insensitive test for their detection. Computed tomography (CT) often identifies occult pneumothoraces (OPTXs). Previous descriptions of OPTX topography have been poor. Our purpose was to define their distribution and aid in the targeting of thoracic ultrasound.MethodsPosttraumatic supine CXRs and CTs were reviewed for occult, overt, and residual PTXs. PTXs were compared according to their apical, basal, anterior, lateral, medial, and posterior components. A comparative size index was calculated.ResultsAmong 761 patients, 338 CT scans revealed 103 PTXs in 89 patients; 55% were OPTXs. OPTXs were apical (57%), basal (41%), anterior (84%), lateral (24%), and medial (27%), with 0% posterior.ConclusionsCXR missed over half of all PTXs. OPTXs had a greater anterior versus lateral (nearly 4-fold) and both basal and apical versus lateral (2-fold) distribution. OPTXs are often located at easily accessible sonographic windows.

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