Radiological and clinical manifestations of pneumothorax

Radiological and clinical manifestations of pneumothorax | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Radiological and clinical manifestations of pneumothorax Hamza Alshhadat, Ibrahim Alatma, Mohammed Alghzali, Khalid Khattab This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6965862/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Spontaneous and traumatic pneumothorax are potentially life-threatening conditions requiring prompt diagnosis. Radiological imaging plays a critical role in detection and classification. Materials and Methods: This retrospective study reviewed medical records and radiological reports of patients diagnosed with pneumothorax at a tertiary hospital. Data collected included demographics, clinical presentation, imaging findings, etiology, recurrence, and complications. Results: Radiologic confirmation of pneumothorax was achieved in 27.3% of suspected cases. Males represented 76% of patients, with a high prevalence of smoking (86%). Dyspnea (82%) and chest pain (66%) were the most common symptoms. Chest X-rays confirmed 86% of cases, while CT had 100% accuracy. Recurrence occurred in 30% of cases, with same-side recurrence more common than contralateral. Conclusion: Radiologic evaluation is essential in the diagnosis and management of pneumothorax. CT remains the gold standard, and recurrence is common, especially among smokers and patients managed conservatively. Pulmonology Pneumothorax Radiology Recurrence Chest X-ray Figures Figure 1 Figure 2 Introduction Pneumothorax is considered one of the important emergencies in daily clinical practice. It results from the presence of air in the pleural cavity, leading to partial or complete collapse of the affected lung. The causes vary between direct or indirect trauma, spontaneous occurrence, or iatrogenic interventions, making its diagnosis and management a significant clinical and radiological challenge [ 1 , 2 ]. Clinically, pneumothorax presents with a range of symptoms, including sudden sharp chest pain and varying degrees of dyspnea, up to cardiopulmonary collapse in cases of tension pneumothorax. The severity of symptoms depends on the volume of intrapleural air, the speed of its accumulation, and the patient’s underlying lung condition [ 3 , 4 ]. Radiologically, chest X-ray remains the first-line diagnostic tool, showing absence of peripheral lung markings and a visible visceral pleural line. High-resolution computed tomography (HRCT) is more sensitive and is used to confirm diagnosis in subtle or small pneumothoraces [ 5 , 6 ]. Pneumothorax is classified into several clinical types: primary spontaneous pneumothorax (PSP), which occurs mainly in tall, thin males with no known lung disease; secondary spontaneous pneumothorax (SSP), associated with underlying conditions like COPD or pulmonary tuberculosis; and traumatic or iatrogenic pneumothorax, such as from mechanical ventilation or lung biopsies [ 7 – 9 ]. Early diagnosis and prompt management of pneumothorax reduce complications and mortality. Management strategies depend on the severity of symptoms and the volume of intrapleural air. Options range from high-flow oxygen and needle aspiration to chest tube insertion or surgical intervention in recurrent or persistent cases [ 10 – 12 ]. This study aims to highlight the various clinical and radiological presentations of pneumothorax and to identify characteristic radiographic patterns and their correlation with clinical findings and pneumothorax type. This would improve diagnostic accuracy and guide appropriate treatment planning. Methods and materials This retrospective cross-sectional study was conducted at Al-Mouwasat University Hospital in Damascus over the years 2022 and 2023, with the aim of investigating the radiological and clinical characteristics of pneumothorax cases that presented to the hospital during this period. A review of the hospital’s medical records was carried out, identifying a total of 2,356 cases in which pneumothorax was listed among the diagnostic entries. After applying strict inclusion and exclusion criteria, a sample of 643 cases with radiologically confirmed pneumothorax—either by standard chest X-ray or computed tomography (CT)—was selected for analysis. The inclusion criteria were based on the presence of clear radiological documentation of pneumothorax, as demonstrated in either conventional chest radiographs or CT scans. Exclusion criteria included all cases that were clinically diagnosed without radiological confirmation, as well as those diagnosed solely by ultrasound without classical imaging modalities. A structured data collection form was developed to document relevant clinical and radiological variables. These included presenting symptoms and clinical signs such as dyspnea, chest pain, and tachypnea. Contributing factors to pneumothorax, especially in smokers, were recorded, in addition to the nature of the initial diagnosis—whether clinical or radiological. The study evaluated the diagnostic accuracy of plain chest radiographs in detecting pneumothorax, as well as additional radiological findings such as atelectasis, pulmonary lesions, or effusions. The role of CT imaging in confirming the diagnosis and detecting subtle or tension pneumothoraces that were missed on plain films was also emphasized. The cases were categorized into primary spontaneous pneumothorax and secondary pneumothorax associated with chronic pulmonary conditions such as COPD or granulomatous diseases. Traumatic pneumothorax and those related to medical interventions (iatrogenic or infectious) were also analyzed. Management strategies were documented, ranging from simple observation and high-flow oxygen administration to chest tube insertion and surgical intervention, particularly in recurrent or tension cases. The distribution of cases by age group and sex was analyzed, and the impact of age on pneumothorax severity and associated complications was assessed. Recurrent pneumothorax, related complications, and key radiological signs of tension pneumothorax—such as mediastinal shift, diaphragmatic flattening, and widened intercostal spaces—were also recorded. Ethical Consideration: Approval for conducting this study was obtained from the Ethics Committee at Al-Mouwasat University Hospital. Patient confidentiality was strictly maintained, and all data were used solely for scientific research purposes without any disclosure of personal identity. All ethical principles of medical research were upheld in accordance with the guidelines of the Declaration of Helsinki. Statistical Analysis: Data entry and analysis were performed using Microsoft Excel. Descriptive statistics were applied to calculate frequencies and percentages for various studied variables, including the distribution of symptoms, radiological diagnostic patterns, management approaches, and their association with etiological factors, age, and gender. No inferential statistical tests were used due to the descriptive nature of the study. Results Pneumothorax was radiologically confirmed in 643 patients out of 2,356 medical records where pneumothorax was mentioned, accounting for 27.3% of the total cases. Males constituted the majority of the confirmed cases, representing 76%, while females comprised 24%. (Fig. 1 ) In terms of smoking status, 86% of the patients were active smokers at the time of diagnosis. Clinically, the most frequently reported symptom was dyspnea, observed in 82% of cases, followed by chest pain in 66%, and tachycardia in 60%. Cyanosis was noted in 23% of the patients. Regarding etiological factors, spontaneous pneumothorax associated with smoking was found in 90% of smokers, while 10% had no clear underlying cause. Initial diagnosis was based on medical history and physical examination, and was subsequently confirmed by radiological imaging. Chest X-rays revealed the presence of pneumothorax in 86% of cases, whereas computed tomography (CT) confirmed the diagnosis in 100%. The visceral pleural line was visible in 86% of radiographs, and the sharp pleural line was observed in 90%. The visceral pleural line was often accompanied by air lucencies on both sides, while skin folds did not coincide with free air, aiding in differential diagnosis. In terms of imaging techniques, all anteroposterior and posteroanterior chest X-rays demonstrated pneumothorax in 100% of cases. Deep inspiration revealed the pathology in 93%, whereas expiratory imaging did so in 7%. The lateral decubitus position helped identify loculated pneumothorax in 15% of cases. Additionally, 12% of the diagnoses were made using portable radiography units in intensive care units. Additional radiographic findings associated with pneumothorax included bilateral pleural effusion in 23%, ipsilateral effusion in 20%, and contralateral effusion in 21%. Pulmonary infiltrates were noted in 25%, lung atelectasis in 43%, and mediastinal shift in 22%. Cardiomegaly appeared in 17% of cases. Radiologic follow-up over one-year post-diagnosis revealed recurrence in the same lung in 25% of cases, no recurrence in 74%, and contralateral recurrence in 19%. High-resolution CT played a crucial role in confirming pneumothorax, particularly in detecting minimal air collections, in line with current radiologic recommendations. Among all cases, secondary spontaneous pneumothorax accounted for 30.8%, with the following etiologies: chronic obstructive pulmonary disease (COPD) in 11.2%, tumors in 1.9%, hydatid disease in 0.8%, pulmonary tuberculosis in 0.8%, sarcoidosis in 0.8%, and other causes in 1.5%. The overall recurrence rate for spontaneous pneumothorax was 30%. Regarding treatment, 42% of patients underwent observation only, 21% received needle aspiration, and 37% required chest tube thoracostomy. Primary spontaneous pneumothorax accounted for 65% of cases, while secondary forms represented 35%. Distribution by age groups was as follows: 1.5% under 10 years, 2.3% between 11–20 years, 3.9% between 21–30 years, 0.8% between 31–40 years, 0.8% between 41–50 years, 3.9% between 51–60 years, and 2.3% between 61–70 years. Traumatic pneumothorax represented a significant proportion of cases, with causes including positive-pressure mechanical ventilation (20%), blunt trauma (25%), and penetrating chest injuries (45%). In supine radiographic evaluation, the following signs were noted: deep costophrenic sulcus sign in 35%, lucent cardiophrenic sulcus in 25%, sharp cardiac or mediastinal contours in 20%, and double diaphragm sign in 20%. On upright chest X-rays, small pneumothoraces were seen in 40% of cases, moderate in 30%, and large pneumothoraces—associated with lung collapse and mediastinal shift—in 30%. Several complications related to pneumothorax were documented, including recurrence in 40%, non-expansion of the collapsed lung in 20%, chronic pneumothorax in 15%, loculated pneumothorax in 10%, bronchopleural fistula in 5%, pneumomediastinum in 5%, and re-expansion pulmonary edema in 5%. (Fig. 2 ) In recurrent pneumothorax cases, 50% recurred on the same side, 15% on the contralateral side, and 35% bilaterally. Finally, in cases of tension pneumothorax, radiological signs included mediastinal shift in 85%, lung collapse in 10%, and flattened diaphragm in 5%. Clinically, this was associated with severe respiratory distress in 40%, distended neck veins in 32%, tracheal deviation in 15%, decreased cardiac output in 8%, and shock in 5%. Discussion The results of this study indicate that spontaneous pneumothorax represents a significant proportion of radiologically confirmed cases at the hospital, with a radiologic confirmation rate of 27.3% among all patients whose records mentioned pneumothorax. This finding aligns with previous global reports; for instance, a British study reported that radiologic diagnosis rates for pneumothorax range between 20–25% of all clinically suspected cases [ 13 ]. In terms of age and sex distribution, males comprised a clear majority (76%), consistent with the global literature indicating that primary spontaneous pneumothorax is more common in young males. This has been attributed to structural factors such as tall and thin body habitus, as well as behavioral factors like smoking [ 14 ]. Moreover, a notably high proportion of patients were smokers (86%), supporting the established causal link between smoking and the development of subpleural blebs. Bense and colleagues demonstrated that smoking increases the risk of pneumothorax by 22-fold [ 15 ]. Clinically, dyspnea was the most frequently reported symptom (82%), followed by chest pain (66%). These are expected findings that reflect the pathophysiology of air accumulation in the pleural space, leading to partial or complete lung collapse. These clinical features are comparable to those reported in studies such as that by Noppen et al., where dyspnea and chest pain were noted in 80% and 70% of patients, respectively [ 16 ]. Radiologically, standard chest X-rays confirmed the diagnosis in 86% of cases, while computed tomography (CT) provided 100% diagnostic confirmation. This aligns with modern guidelines that consider CT the gold standard for detecting small or loculated pneumothoraces [ 17 ]. Classical signs such as the visceral pleural line were frequently seen, underscoring the importance of training resident physicians to distinguish between genuine radiologic signs and misleading ones, such as skin folds. Regarding radiographic positioning, this study found that deep inspiratory films revealed pneumothorax in 93% of cases, affirming the efficacy of this technique. These findings are in line with the recommendations of the British Thoracic Society as outlined by MacDuff et al. [ 18 ]. The recurrence rate of 30% observed in this study is clinically significant, especially considering that international studies have reported recurrence rates after primary pneumothorax of up to 32% within the first year, increasing to 62% after the first recurrence [ 19 ]. The study also showed that same-side recurrence (25%) was more common than contralateral recurrence (19%), which supports the predominantly localized nature of the disease. The study revealed a clear pathological distribution in cases of secondary pneumothorax, with chronic obstructive pulmonary disease (COPD) being the most common cause (11.2%), followed by tumors and hydatid disease. These findings are consistent with the literature, which shows that secondary pneumothorax frequently occurs in patients with advanced COPD [ 20 ]. In terms of traumatic pneumothorax etiology, the highest incidence was observed in penetrating chest injuries (45%), followed by blunt trauma (25%) and mechanical ventilation (20%). These results highlight the importance of close monitoring in trauma patients, particularly those receiving positive-pressure ventilation, which increases the risk of alveolar rupture. Regarding complications, recurrence was the most common (40%), followed by failure of lung re-expansion (20%) and chronic pneumothorax (15%). These complications are well documented in the literature and require careful follow-up strategies, especially in conservatively managed patients who do not undergo surgical intervention. Finally, the clinical and radiological features of tension pneumothorax were distinctive, particularly mediastinal shift, which was observed in 85% of cases. This high percentage necessitates immediate intervention, consistent with the guidelines of the UK’s National Institute for Health and Care Excellence (NICE), which classifies tension pneumothorax as a medical emergency requiring prompt air evacuation to prevent cardiac arrest [ 18 ]. Conclusion This study highlights the significant prevalence of pneumothorax confirmed by radiological imaging, accounting for 27.3% of suspected cases. The majority of patients were young males with a high rate of smoking, supporting the known association between smoking and spontaneous pneumothorax. Clinical symptoms were predominantly dyspnea and chest pain, consistent with previous literature. Chest X-ray showed high diagnostic value, but CT scan remained the definitive tool with 100% accuracy. Recurrence rates were considerable, especially on the same side, emphasizing the need for careful follow-up. Early recognition and appropriate management are crucial to reduce complications and improve patient outcomes. Declarations Acknowledgments: The authors express their sincere gratitude to the staff of Al-Mouwasat University Hospital for their assistance in facilitating access to medical records and supporting this study. Funding Statement: This research did not receive any specific funding from public, commercial, or non-profit organizations. Conflict of Interest Statement: The authors declare no conflicts of interest related to this study. Data Availability Statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request, in accordance with institutional policies and confidentiality requirements. Ethical Statement: This retrospective study was conducted following the ethical guidelines of Al-Mouwasat University Hospital’s Research Ethics Committee. Approval was obtained under protocol number 1976/MO/2025. Patient consent was waived due to the use of anonymized medical records. References Light RW. Pneumothorax. In: Pleural Diseases. 6th ed. Lippincott Williams & Wilkins; 2013. p. 326–51. Noppen M, De Keukeleire T. Pneumothorax. Respiration. 2008;76(2):121–7. Bintcliffe OJ, Maskell NA. Spontaneous pneumothorax. BMJ. 2014;348: g2928. Baumann MH, Noppen M. Pneumothorax. Respirology. 2004;9(2):157–64. Hirai S, Hamanaka Y, Mitsui N, Uegami S, Morifuji K. The value of CT in pneumothorax. Ann Thorac Cardiovasc Surg. 2001;7(6):327–31. Hallifax RJ, Talwar A, Wrightson JM, Edey AJ, Gleeson FV, Rahman NM. State-of-the-art: radiological investigation of pneumothorax. Clin Radiol. 2014;69(5): e1–e10. Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000;342(12):868–74. Tschopp JM, Rami-Porta R, Noppen M, Astoul P. Management of spontaneous pneumothorax: state of the art. Eur Respir J. 2006;28(3):637–50. MacDuff A, Arnold A, Harvey J; BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2: ii18–ii31. Chen CH, Hsu WH, Shih CM, Huang YK, Chou TY, Lee JM. Thoracoscopic surgery as a definitive treatment for primary spontaneous pneumothorax. J Formos Med Assoc. 2006;105(6):469–76. Henry M, Arnold T, Harvey J; BTS Pleural Disease Guideline Group. BTS guidelines for the management of spontaneous pneumothorax. Thorax. 2003;58 Suppl 2: ii39–52. Kelly AM, Druda D. Comparison of size classification of pneumothorax by three international guidelines: a case for international consensus? Respiration. 2008;76(4):386–91. Hallifax RJ, Goldacre R, Landray MJ, Rahman NM, Goldacre MJ. Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax in England: A Population-Based Study. Chest. 2017;152(2):440-446. Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000;342(12):868-874. Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest. 1987;92(6):1009-1012. Noppen M, Meysman M, Dekeukeleire T, D’Haese J, Gerlo E, Vincken W. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized study. Am J Respir Crit Care Med. 2002;165(9):1240-1244. Zhang X, Li Q, Ma D, et al. Diagnostic accuracy of chest radiography versus computed tomography in pneumothorax: A meta-analysis. Medicine (Baltimore). 2020;99(24): e20779. MacDuff A, Arnold A, Harvey J; BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(Suppl 2): ii18-ii31. Tschopp JM, Bintcliffe O, Astoul P, et al. ERS task force statement: management of spontaneous pneumothorax. Eur Respir J. 2015;46(2):321-335. Light RW. Pneumothorax. In: Light RW, editor. Pleural Diseases. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 326–356. Additional Declarations The authors declare potential competing interests as follows: no Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6965862","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475770946,"identity":"1add76ea-cded-4103-8ee6-a2eefaf4eb72","order_by":0,"name":"Hamza Alshhadat","email":"","orcid":"","institution":"Faculty of medicine, AL-Sham Private University, Damascus, Syria.","correspondingAuthor":false,"prefix":"","firstName":"Hamza","middleName":"","lastName":"Alshhadat","suffix":""},{"id":475770947,"identity":"29f13fce-7283-4069-a629-a87575e126dd","order_by":1,"name":"Ibrahim Alatma","email":"data:image/png;base64,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","orcid":"","institution":"Faculty of medicine, AL-Sham Private University, Damascus, Syria.","correspondingAuthor":true,"prefix":"","firstName":"Ibrahim","middleName":"","lastName":"Alatma","suffix":""},{"id":475770948,"identity":"546604a9-83ee-4aec-ae9e-a63a5b1eed46","order_by":2,"name":"Mohammed Alghzali","email":"","orcid":"","institution":"Faculty of medicine, AL-Sham Private University, Damascus, Syria.","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Alghzali","suffix":""},{"id":475770949,"identity":"f3505c79-3091-4dfe-adb8-af80bea6aded","order_by":3,"name":"Khalid Khattab","email":"","orcid":"","institution":"Department of Radiology, Damascus University, Syrian Private University, AL- Sham Private University, Rif Dimashq, Syria","correspondingAuthor":false,"prefix":"","firstName":"Khalid","middleName":"","lastName":"Khattab","suffix":""}],"badges":[],"createdAt":"2025-06-24 12:45:18","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6965862/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6965862/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85507121,"identity":"95cc69b8-2fd9-42b4-bdff-14d7bb64cd87","added_by":"auto","created_at":"2025-06-26 15:39:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13358,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRelative distribution of patients by gender\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6965862/v1/07c011d07135faec41d9199f.png"},{"id":85507122,"identity":"d786f3ba-c1a1-4b1a-8e84-d57b84ed4a34","added_by":"auto","created_at":"2025-06-26 15:39:49","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":40681,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComplications seen in patients\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6965862/v1/eba2297e1d405bb06a107292.png"},{"id":85507128,"identity":"81add1db-a4c1-4b0f-8121-66b0ce50d71a","added_by":"auto","created_at":"2025-06-26 15:39:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":443480,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6965862/v1/a2983db7-f824-4229-adf7-5faa9c5b44e7.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: no","formattedTitle":"\u003cp\u003e\u003cstrong\u003eRadiological and clinical manifestations of pneumothorax\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePneumothorax is considered one of the important emergencies in daily clinical practice. It results from the presence of air in the pleural cavity, leading to partial or complete collapse of the affected lung. The causes vary between direct or indirect trauma, spontaneous occurrence, or iatrogenic interventions, making its diagnosis and management a significant clinical and radiological challenge [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinically, pneumothorax presents with a range of symptoms, including sudden sharp chest pain and varying degrees of dyspnea, up to cardiopulmonary collapse in cases of tension pneumothorax. The severity of symptoms depends on the volume of intrapleural air, the speed of its accumulation, and the patient\u0026rsquo;s underlying lung condition [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRadiologically, chest X-ray remains the first-line diagnostic tool, showing absence of peripheral lung markings and a visible visceral pleural line. High-resolution computed tomography (HRCT) is more sensitive and is used to confirm diagnosis in subtle or small pneumothoraces [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePneumothorax is classified into several clinical types: primary spontaneous pneumothorax (PSP), which occurs mainly in tall, thin males with no known lung disease; secondary spontaneous pneumothorax (SSP), associated with underlying conditions like COPD or pulmonary tuberculosis; and traumatic or iatrogenic pneumothorax, such as from mechanical ventilation or lung biopsies [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly diagnosis and prompt management of pneumothorax reduce complications and mortality. Management strategies depend on the severity of symptoms and the volume of intrapleural air. Options range from high-flow oxygen and needle aspiration to chest tube insertion or surgical intervention in recurrent or persistent cases [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aims to highlight the various clinical and radiological presentations of pneumothorax and to identify characteristic radiographic patterns and their correlation with clinical findings and pneumothorax type. This would improve diagnostic accuracy and guide appropriate treatment planning.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cp\u003eThis retrospective cross-sectional study was conducted at Al-Mouwasat University Hospital in Damascus over the years 2022 and 2023, with the aim of investigating the radiological and clinical characteristics of pneumothorax cases that presented to the hospital during this period. A review of the hospital\u0026rsquo;s medical records was carried out, identifying a total of 2,356 cases in which pneumothorax was listed among the diagnostic entries. After applying strict inclusion and exclusion criteria, a sample of 643 cases with radiologically confirmed pneumothorax\u0026mdash;either by standard chest X-ray or computed tomography (CT)\u0026mdash;was selected for analysis.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were based on the presence of clear radiological documentation of pneumothorax, as demonstrated in either conventional chest radiographs or CT scans. Exclusion criteria included all cases that were clinically diagnosed without radiological confirmation, as well as those diagnosed solely by ultrasound without classical imaging modalities.\u003c/p\u003e \u003cp\u003eA structured data collection form was developed to document relevant clinical and radiological variables. These included presenting symptoms and clinical signs such as dyspnea, chest pain, and tachypnea. Contributing factors to pneumothorax, especially in smokers, were recorded, in addition to the nature of the initial diagnosis\u0026mdash;whether clinical or radiological. The study evaluated the diagnostic accuracy of plain chest radiographs in detecting pneumothorax, as well as additional radiological findings such as atelectasis, pulmonary lesions, or effusions. The role of CT imaging in confirming the diagnosis and detecting subtle or tension pneumothoraces that were missed on plain films was also emphasized.\u003c/p\u003e \u003cp\u003eThe cases were categorized into primary spontaneous pneumothorax and secondary pneumothorax associated with chronic pulmonary conditions such as COPD or granulomatous diseases. Traumatic pneumothorax and those related to medical interventions (iatrogenic or infectious) were also analyzed. Management strategies were documented, ranging from simple observation and high-flow oxygen administration to chest tube insertion and surgical intervention, particularly in recurrent or tension cases. The distribution of cases by age group and sex was analyzed, and the impact of age on pneumothorax severity and associated complications was assessed. Recurrent pneumothorax, related complications, and key radiological signs of tension pneumothorax\u0026mdash;such as mediastinal shift, diaphragmatic flattening, and widened intercostal spaces\u0026mdash;were also recorded.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthical Consideration:\u003c/h2\u003e \u003cp\u003e Approval for conducting this study was obtained from the Ethics Committee at Al-Mouwasat University Hospital. Patient confidentiality was strictly maintained, and all data were used solely for scientific research purposes without any disclosure of personal identity. All ethical principles of medical research were upheld in accordance with the guidelines of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eData entry and analysis were performed using Microsoft Excel. Descriptive statistics were applied to calculate frequencies and percentages for various studied variables, including the distribution of symptoms, radiological diagnostic patterns, management approaches, and their association with etiological factors, age, and gender. No inferential statistical tests were used due to the descriptive nature of the study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003ePneumothorax was radiologically confirmed in 643 patients out of 2,356 medical records where pneumothorax was mentioned, accounting for 27.3% of the total cases. Males constituted the majority of the confirmed cases, representing 76%, while females comprised 24%. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) In terms of smoking status, 86% of the patients were active smokers at the time of diagnosis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eClinically, the most frequently reported symptom was dyspnea, observed in 82% of cases, followed by chest pain in 66%, and tachycardia in 60%. Cyanosis was noted in 23% of the patients.\u003c/p\u003e \u003cp\u003eRegarding etiological factors, spontaneous pneumothorax associated with smoking was found in 90% of smokers, while 10% had no clear underlying cause. Initial diagnosis was based on medical history and physical examination, and was subsequently confirmed by radiological imaging.\u003c/p\u003e \u003cp\u003eChest X-rays revealed the presence of pneumothorax in 86% of cases, whereas computed tomography (CT) confirmed the diagnosis in 100%. The visceral pleural line was visible in 86% of radiographs, and the sharp pleural line was observed in 90%. The visceral pleural line was often accompanied by air lucencies on both sides, while skin folds did not coincide with free air, aiding in differential diagnosis.\u003c/p\u003e \u003cp\u003eIn terms of imaging techniques, all anteroposterior and posteroanterior chest X-rays demonstrated pneumothorax in 100% of cases. Deep inspiration revealed the pathology in 93%, whereas expiratory imaging did so in 7%. The lateral decubitus position helped identify loculated pneumothorax in 15% of cases. Additionally, 12% of the diagnoses were made using portable radiography units in intensive care units.\u003c/p\u003e \u003cp\u003eAdditional radiographic findings associated with pneumothorax included bilateral pleural effusion in 23%, ipsilateral effusion in 20%, and contralateral effusion in 21%. Pulmonary infiltrates were noted in 25%, lung atelectasis in 43%, and mediastinal shift in 22%. Cardiomegaly appeared in 17% of cases.\u003c/p\u003e \u003cp\u003eRadiologic follow-up over one-year post-diagnosis revealed recurrence in the same lung in 25% of cases, no recurrence in 74%, and contralateral recurrence in 19%.\u003c/p\u003e \u003cp\u003eHigh-resolution CT played a crucial role in confirming pneumothorax, particularly in detecting minimal air collections, in line with current radiologic recommendations.\u003c/p\u003e \u003cp\u003eAmong all cases, secondary spontaneous pneumothorax accounted for 30.8%, with the following etiologies: chronic obstructive pulmonary disease (COPD) in 11.2%, tumors in 1.9%, hydatid disease in 0.8%, pulmonary tuberculosis in 0.8%, sarcoidosis in 0.8%, and other causes in 1.5%.\u003c/p\u003e \u003cp\u003eThe overall recurrence rate for spontaneous pneumothorax was 30%. Regarding treatment, 42% of patients underwent observation only, 21% received needle aspiration, and 37% required chest tube thoracostomy.\u003c/p\u003e \u003cp\u003ePrimary spontaneous pneumothorax accounted for 65% of cases, while secondary forms represented 35%. Distribution by age groups was as follows: 1.5% under 10 years, 2.3% between 11\u0026ndash;20 years, 3.9% between 21\u0026ndash;30 years, 0.8% between 31\u0026ndash;40 years, 0.8% between 41\u0026ndash;50 years, 3.9% between 51\u0026ndash;60 years, and 2.3% between 61\u0026ndash;70 years.\u003c/p\u003e \u003cp\u003eTraumatic pneumothorax represented a significant proportion of cases, with causes including positive-pressure mechanical ventilation (20%), blunt trauma (25%), and penetrating chest injuries (45%).\u003c/p\u003e \u003cp\u003eIn supine radiographic evaluation, the following signs were noted: deep costophrenic sulcus sign in 35%, lucent cardiophrenic sulcus in 25%, sharp cardiac or mediastinal contours in 20%, and double diaphragm sign in 20%.\u003c/p\u003e \u003cp\u003eOn upright chest X-rays, small pneumothoraces were seen in 40% of cases, moderate in 30%, and large pneumothoraces\u0026mdash;associated with lung collapse and mediastinal shift\u0026mdash;in 30%.\u003c/p\u003e \u003cp\u003eSeveral complications related to pneumothorax were documented, including recurrence in 40%, non-expansion of the collapsed lung in 20%, chronic pneumothorax in 15%, loculated pneumothorax in 10%, bronchopleural fistula in 5%, pneumomediastinum in 5%, and re-expansion pulmonary edema in 5%. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn recurrent pneumothorax cases, 50% recurred on the same side, 15% on the contralateral side, and 35% bilaterally.\u003c/p\u003e \u003cp\u003eFinally, in cases of tension pneumothorax, radiological signs included mediastinal shift in 85%, lung collapse in 10%, and flattened diaphragm in 5%. Clinically, this was associated with severe respiratory distress in 40%, distended neck veins in 32%, tracheal deviation in 15%, decreased cardiac output in 8%, and shock in 5%.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study indicate that spontaneous pneumothorax represents a significant proportion of radiologically confirmed cases at the hospital, with a radiologic confirmation rate of 27.3% among all patients whose records mentioned pneumothorax. This finding aligns with previous global reports; for instance, a British study reported that radiologic diagnosis rates for pneumothorax range between 20\u0026ndash;25% of all clinically suspected cases [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn terms of age and sex distribution, males comprised a clear majority (76%), consistent with the global literature indicating that primary spontaneous pneumothorax is more common in young males. This has been attributed to structural factors such as tall and thin body habitus, as well as behavioral factors like smoking [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, a notably high proportion of patients were smokers (86%), supporting the established causal link between smoking and the development of subpleural blebs. Bense and colleagues demonstrated that smoking increases the risk of pneumothorax by 22-fold [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinically, dyspnea was the most frequently reported symptom (82%), followed by chest pain (66%). These are expected findings that reflect the pathophysiology of air accumulation in the pleural space, leading to partial or complete lung collapse. These clinical features are comparable to those reported in studies such as that by Noppen et al., where dyspnea and chest pain were noted in 80% and 70% of patients, respectively [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRadiologically, standard chest X-rays confirmed the diagnosis in 86% of cases, while computed tomography (CT) provided 100% diagnostic confirmation. This aligns with modern guidelines that consider CT the gold standard for detecting small or loculated pneumothoraces [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Classical signs such as the visceral pleural line were frequently seen, underscoring the importance of training resident physicians to distinguish between genuine radiologic signs and misleading ones, such as skin folds.\u003c/p\u003e \u003cp\u003eRegarding radiographic positioning, this study found that deep inspiratory films revealed pneumothorax in 93% of cases, affirming the efficacy of this technique. These findings are in line with the recommendations of the British Thoracic Society as outlined by MacDuff et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe recurrence rate of 30% observed in this study is clinically significant, especially considering that international studies have reported recurrence rates after primary pneumothorax of up to 32% within the first year, increasing to 62% after the first recurrence [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The study also showed that same-side recurrence (25%) was more common than contralateral recurrence (19%), which supports the predominantly localized nature of the disease.\u003c/p\u003e \u003cp\u003eThe study revealed a clear pathological distribution in cases of secondary pneumothorax, with chronic obstructive pulmonary disease (COPD) being the most common cause (11.2%), followed by tumors and hydatid disease. These findings are consistent with the literature, which shows that secondary pneumothorax frequently occurs in patients with advanced COPD [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn terms of traumatic pneumothorax etiology, the highest incidence was observed in penetrating chest injuries (45%), followed by blunt trauma (25%) and mechanical ventilation (20%). These results highlight the importance of close monitoring in trauma patients, particularly those receiving positive-pressure ventilation, which increases the risk of alveolar rupture.\u003c/p\u003e \u003cp\u003eRegarding complications, recurrence was the most common (40%), followed by failure of lung re-expansion (20%) and chronic pneumothorax (15%). These complications are well documented in the literature and require careful follow-up strategies, especially in conservatively managed patients who do not undergo surgical intervention.\u003c/p\u003e \u003cp\u003eFinally, the clinical and radiological features of tension pneumothorax were distinctive, particularly mediastinal shift, which was observed in 85% of cases. This high percentage necessitates immediate intervention, consistent with the guidelines of the UK\u0026rsquo;s National Institute for Health and Care Excellence (NICE), which classifies tension pneumothorax as a medical emergency requiring prompt air evacuation to prevent cardiac arrest [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the significant prevalence of pneumothorax confirmed by radiological imaging, accounting for 27.3% of suspected cases. The majority of patients were young males with a high rate of smoking, supporting the known association between smoking and spontaneous pneumothorax. Clinical symptoms were predominantly dyspnea and chest pain, consistent with previous literature. Chest X-ray showed high diagnostic value, but CT scan remained the definitive tool with 100% accuracy. Recurrence rates were considerable, especially on the same side, emphasizing the need for careful follow-up. Early recognition and appropriate management are crucial to reduce complications and improve patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their sincere gratitude to the staff of Al-Mouwasat University Hospital for their assistance in facilitating access to medical records and supporting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific funding from public, commercial, or non-profit organizations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available from the corresponding author upon reasonable request, in accordance with institutional policies and confidentiality requirements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was conducted following the ethical guidelines of Al-Mouwasat University Hospital\u0026rsquo;s Research Ethics Committee. Approval was obtained under protocol number 1976/MO/2025. Patient consent was waived due to the use of anonymized medical records.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLight RW. Pneumothorax. In: Pleural Diseases. 6th ed. Lippincott Williams \u0026amp; Wilkins; 2013. p. 326\u0026ndash;51.\u003c/li\u003e\n\u003cli\u003eNoppen M, De Keukeleire T. Pneumothorax. Respiration. 2008;76(2):121\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eBintcliffe OJ, Maskell NA. Spontaneous pneumothorax. BMJ. 2014;348: g2928.\u003c/li\u003e\n\u003cli\u003eBaumann MH, Noppen M. Pneumothorax. Respirology. 2004;9(2):157\u0026ndash;64.\u003c/li\u003e\n\u003cli\u003eHirai S, Hamanaka Y, Mitsui N, Uegami S, Morifuji K. The value of CT in pneumothorax. Ann Thorac Cardiovasc Surg. 2001;7(6):327\u0026ndash;31.\u003c/li\u003e\n\u003cli\u003eHallifax RJ, Talwar A, Wrightson JM, Edey AJ, Gleeson FV, Rahman NM. State-of-the-art: radiological investigation of pneumothorax. Clin Radiol. 2014;69(5): e1\u0026ndash;e10.\u003c/li\u003e\n\u003cli\u003eSahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000;342(12):868\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003eTschopp JM, Rami-Porta R, Noppen M, Astoul P. Management of spontaneous pneumothorax: state of the art. Eur Respir J. 2006;28(3):637\u0026ndash;50.\u003c/li\u003e\n\u003cli\u003eMacDuff A, Arnold A, Harvey J; BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2: ii18\u0026ndash;ii31.\u003c/li\u003e\n\u003cli\u003eChen CH, Hsu WH, Shih CM, Huang YK, Chou TY, Lee JM. Thoracoscopic surgery as a definitive treatment for primary spontaneous pneumothorax. J Formos Med Assoc. 2006;105(6):469\u0026ndash;76.\u003c/li\u003e\n\u003cli\u003eHenry M, Arnold T, Harvey J; BTS Pleural Disease Guideline Group. BTS guidelines for the management of spontaneous pneumothorax. Thorax. 2003;58 Suppl 2: ii39\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eKelly AM, Druda D. Comparison of size classification of pneumothorax by three international guidelines: a case for international consensus? Respiration. 2008;76(4):386\u0026ndash;91.\u003c/li\u003e\n\u003cli\u003eHallifax RJ, Goldacre R, Landray MJ, Rahman NM, Goldacre MJ. Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax in England: A Population-Based Study. Chest. 2017;152(2):440-446.\u003c/li\u003e\n\u003cli\u003eSahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000;342(12):868-874.\u003c/li\u003e\n\u003cli\u003eBense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest. 1987;92(6):1009-1012.\u003c/li\u003e\n\u003cli\u003eNoppen M, Meysman M, Dekeukeleire T, D\u0026rsquo;Haese J, Gerlo E, Vincken W. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax: a multicenter, prospective, randomized study. Am J Respir Crit Care Med. 2002;165(9):1240-1244.\u003c/li\u003e\n\u003cli\u003eZhang X, Li Q, Ma D, et al. Diagnostic accuracy of chest radiography versus computed tomography in pneumothorax: A meta-analysis. Medicine (Baltimore). 2020;99(24): e20779.\u003c/li\u003e\n\u003cli\u003eMacDuff A, Arnold A, Harvey J; BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65(Suppl 2): ii18-ii31.\u003c/li\u003e\n\u003cli\u003eTschopp JM, Bintcliffe O, Astoul P, et al. ERS task force statement: management of spontaneous pneumothorax. Eur Respir J. 2015;46(2):321-335.\u003c/li\u003e\n\u003cli\u003eLight RW. Pneumothorax. In: Light RW, editor. Pleural Diseases. 6th ed. Philadelphia: Lippincott Williams \u0026amp; Wilkins; 2013. p. 326\u0026ndash;356.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"c50795a6-8330-49a4-b160-70087ad13dc1","identifier":"10.13039/100016418","name":"B.K. Kee Foundation","awardNumber":"0507547152","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Al-Sham Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pneumothorax, Radiology, Recurrence, Chest X-ray","lastPublishedDoi":"10.21203/rs.3.rs-6965862/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6965862/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eSpontaneous and traumatic pneumothorax are potentially life-threatening conditions requiring prompt diagnosis. Radiological imaging plays a critical role in detection and classification.\u003c/p\u003e\u003ch2\u003eMaterials and Methods:\u003c/h2\u003e \u003cp\u003eThis retrospective study reviewed medical records and radiological reports of patients diagnosed with pneumothorax at a tertiary hospital. Data collected included demographics, clinical presentation, imaging findings, etiology, recurrence, and complications.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eRadiologic confirmation of pneumothorax was achieved in 27.3% of suspected cases. Males represented 76% of patients, with a high prevalence of smoking (86%). Dyspnea (82%) and chest pain (66%) were the most common symptoms. Chest X-rays confirmed 86% of cases, while CT had 100% accuracy. Recurrence occurred in 30% of cases, with same-side recurrence more common than contralateral.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eRadiologic evaluation is essential in the diagnosis and management of pneumothorax. CT remains the gold standard, and recurrence is common, especially among smokers and patients managed conservatively.\u003c/p\u003e","manuscriptTitle":"Radiological and clinical manifestations of pneumothorax","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-26 15:39:44","doi":"10.21203/rs.3.rs-6965862/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"406670ee-7c3c-461f-b09f-aeca54822676","owner":[],"postedDate":"June 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":50519482,"name":"Pulmonology"}],"tags":[],"updatedAt":"2025-06-26T15:39:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-26 15:39:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6965862","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6965862","identity":"rs-6965862","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}