The present study compared the clinical,
laboratory, and imaging characteristics of patients
diagnosed with PM in the ED, grouping them as either spontaneous or traumatic PM. The
predominance of male patients in both groups is
consistent with existing research, which indicates
that spontaneous PM is more commonly seen in
young, healthy males.[
11,
12] The higher median age in
the traumatic PM group may reflect the increased
likelihood of trauma, invasive interventions, or
serious systemic illnesses in these patients.[
13]
Imaging results showed that chest X-rays were
used more often in spontaneous PM cases, while
CT scans were more commonly performed for
traumatic PM. This suggests that CT improves
diagnostic precision, particularly for traumatic PM.
Choi et al.[14] similarly found that the presence
of subcutaneous emphysema on radiography often
indicates pneumothorax or PM on CT. When CT
is not practical, such as for patients with unstable vital signs in the ED, radiographic findings become
critically important for guiding management.
Serum lactate is a commonly used biomarker
that indicates tissue hypoxia and inadequate
perfusion.[15,16] Elevated lactate levels can help guide
early fluid resuscitation in trauma patients and
may also predict mortality risk.[17,18] Çınar et al.[19]
showed that rising lactate levels in patients with
thoracic trauma are an important indicator of
prognosis. Işık et al.[20] reported that lactate levels
were higher in traumatic cases while examining
the causes of PM. Similarly, our study found that
lactate levels were significantly higher in patients
with traumatic PM. This increase may result not
only from hemodynamic instability, but also from
adrenergic system activation due to pain and stress.
However, lactate can also be elevated in other conditions such as sepsis, gastrointestinal bleeding,
and kidney or liver dysfunction, which may limit
its reliability as a prognostic marker. Patients with
traumatic PM had higher lactate levels and were
more likely to be admitted to intensive care. High
blood lactate levels influence the decision to admit
patients to intensive care.
Further analysis showed that clinical outcomes
indicated spontaneous PM cases were more often
admitted to the ward, while traumatic PM patients
were referred more frequently. It is well established
that spontaneous PM usually has a good prognosis
and is usually treated conservatively.[21,22] However,
it is notable that the mortality rate in our study was
unexpectedly high at 23.1% for both groups. This
may be due to the presence of comorbid conditions
or differences in how cases were classified. Reports
have shown that in PM cases related to COVID-19,
PM can develop even in patients not on ventilators,
which may signal a worse prognosis.[12,23] Many
patients with traumatic PM had to be referred to
other centers, as our hospital did not have a thoracic
surgeon, requiring a multidisciplinary approach for
their follow-up.
Nonetheless, this study has certain limitations.
First, since it was a single-center retrospective
study, the data may be incomplete or inaccurate.
The classification of PM as spontaneous or
traumatic relied on clinical evaluation, which
means some cases might have been misclassified.
Furthermore, imaging was evaluated using
radiology reports without independent review.
Although subcutaneous emphysema was confirmed
by CT or radiography, its extent or severity
could not be evaluated. Therefore, further multicenter,
prospective studies are needed to clarify
which biomarkers and imaging findings can better
determine prognosis in PM cases.
In conclusion, our study results demonstrate
the clinical distinctions between spontaneous
and traumatic PM in emergency settings. Higher
lactate levels and trauma-related findings indicate
a more severe course in traumatic cases. Computed
tomography remains crucial for diagnosis. Identifying
features specific to the underlying cause can help
guide management and improve patient outcomes.
Additional studies are needed to confirm these
findings.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Author Contributions: Idea/concept: M.A.; Design,
control/supervision, analysis and interpretation, writing the
article, critical review: M.A., İ.A.; Data collection and/or
interpretation, literature review: İ.A.
Conflict of Interest: The authors declared no conflicts
of interest with respect to the authorship and/or publication
of this article.
Funding: The authors received no financial support for
the research and/or authorship of this article.
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