Radiologic Evaluation of Alternative Sites for Successful Needle Decompression of Pneumothorax

INTRODUCTION: The aim of this study was to evaluate chest wall thickness (CWT) using computed tomography (CT) and to determine which anatomic region should be selected for a successful needle thoracostomy (NT) procedure site in patients with a pneumothorax (PTX).
METHODS: The 147 patients who had thorax CT in the emergency department (ED) were included. The CWTs at the 2nd intercostal space (ICS) midclavicular line (MCL), at the 5th ICS midaxillary line (MAL), and the anterior axillary line (AAL) were measured on both sides.
RESULTS: The median CWTs were 27.2 mm and 27.3 mm on the right and left sides of the 2nd ICS-MCL, respectively. The median CWTs were 43.5 mm on the right and 43.8 mm on the left side of the 5th ICS-MAL. The median CWTs were 32.2 mm on the right and 31.2 mm on the left 5th ICS-AAL. This study also showed that when a standard 50-mm catheter was used, NT failed in 12.9% of patients in the 2nd ICS-MCL, in 67.4% of patients in the 5th ICS-MAL, and in 27.2% of patients in the 5th ICS-AAL.
DISCUSSION AND CONCLUSION: Our study confirmed that a 50-mm catheter, which is used classically in tension pneumothorax cases, has higher success rates than the 5th ICS when applied from the 2nd ICS. It should be noted that the thickness of the thorax wall increases in proportion to body mass index, which may lead to a failure of the procedure.