Enter the interpleural distances (in cm):Apex of hemithorax to top of collapsed lung:
Midpoint from Top to Mid Portion of Collapsed Lung:
Midpoint from Mid to Lower Portion of Collapsed Lung:
Formula for calculating Pneumothorax Volume based on Collins Method using Interpleural Distances:
Pneumothorax Volume Percentage = 4.2 + [4.7 x A+ B + C]
A + B + C = Sum of Interpleural Distances.
4.2 = Correction Factor.
|Sum of Interpleural Distance (cm)||Percentage volume of Pneumothorax|
What are the different methods to estimate pneumothorax on chest radiographs?
To calculate the light index, 2 measurements are required,
DL – Diameter of the collapsed lung
DH – Diameter of the hemithorax on the collapsed side
Light index is given : % of pneumothorax = 100−(DL3/DH3×100)
Average interpleural distances (AID) measured in centimeters at the apex, midpoint of the upper half of the lung, and midpoint of the lower half of the lung on an erect chest X-ray to estimate pneumothorax size in percent by using a nomogram.
Collins Method :
Collins method is based on the formula mentioned above.
Here is an excerpt from the methods section of that study:
"All patients underwent an erect inspiratory posteroanterior radiograph and a helical CT scan of the thorax on the same visit to the radiology department. The interpleural distance was measured at three locations, and the figures were added together. Following helical CT of the thorax, the percentage pneumothorax size was calculated by drawing regions of interest around the relevant hemithorax and lung on 10-mm reconstructed
slices. A scattergram of the sum of interpleural distances in centimeters versus percentage pneumothorax size was plotted"
American Thoracic Society (ATS) Guidelines:
Distance from the apex of the chest to the lung cupola in cm.
British Thoracic Society (BTS)
Distance between the lung margin and the chest wall at the level of the hilum
Which is the most accurate method for estimating Pneumothorax volume on a chest radiograph?
Collins Method is the most accurate among the presently available methods.
When is intervention suggested for a pneumothorax?
Conservative management is suggested for small pneumothoraces, while larger pneumothoraces need intervention.
Definitions of small pneumothorax include:
- BTS Method: <2 cm between the lung margin and the chest wall at the level of the hilum
- ATS Method: <3 cm from apex to cupola (ATS)
- Light's, Rhea and Collins Method: <25%
- Quantification of pneumothorax size on chest radiographs using interpleural distances: regression analysis based on volume measurements from helical CT. C D Collins, A Lopez, A Mathie, V Wood, J E Jackson, and M E Roddie American Journal of Roentgenology 1995 165:5, 1127-1130
- Devaraj, U., Ramachandran, P., Krishnaswamy, U. et al. Comparison of methods to quantitate spontaneous pneumothorax — A study from a tertiary care hospital. Egypt J Bronchol 13, 388–393 (2019).
- Kelly AM, Loy J, Tsang AY, Graham CA. Estimating the rate of re-expansion of spontaneous pneumothorax by a formula derived from computed tomography volumetry studies. Emerg Med J. 2006;23(10):780-782. doi:10.1136/emj.2006.037143
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Disclaimer: The author makes no claims of the accuracy of the information contained herein; this information is for educational purposes only and is not a substitute for clinical judgment.