Pulmonary Embolism vs Pneumothorax
Pulmonary Embolism and Pneumothorax are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Pulmonary Embolism vs Pneumothorax at a glance
- Pulmonary Embolism: Obstruction of pulmonary arterial circulation, usually by deep venous thrombus.
- Pneumothorax: Air in the pleural space — spontaneous, traumatic, iatrogenic, or tension physiology.
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Side-by-side comparison
| Feature | Pulmonary Embolism | Pneumothorax |
|---|---|---|
| At a glance | Obstruction of pulmonary arterial circulation, usually by deep venous thrombus. | Air in the pleural space — spontaneous, traumatic, iatrogenic, or tension physiology. |
| Classic presentation | Hampton hump (peripheral wedge-shaped opacity), Westermark sign (focal oligemia), Fleischner sign (enlarged pulmonary artery) on CXR — all insensitive.;… | Sudden unilateral pleuritic pain + decreased breath sounds + hyperresonance in tall, thin young man = primary spontaneous pneumothorax until proven… |
| Workup / key labs | Confirmed PE on imaging. Use validated clinical decision rules: Wells score (low <2, moderate 2-6, high >6) or revised Geneva. PERC rule (8 criteria) can… | Confirmed by imaging in stable patient. Tension PTX is a CLINICAL diagnosis (hypotension, absent breath sounds, distended neck veins) requiring immediate… |
| Imaging | CT pulmonary angiography (CTPA) — gold standard if no contraindication; V/Q scan — alternative if CTPA contraindicated (renal failure, contrast allergy,… | Upright PA chest radiograph — visceral pleural line with absent lung markings peripheral to it; Expiratory or lateral decubitus views increase sensitivity for… |
| First-line treatment | Anticoagulation while awaiting imaging if high clinical suspicion and low bleeding risk; Hemodynamically stable PE: direct oral anticoagulant (DOAC) preferred… | Tension pneumothorax (CLINICAL DIAGNOSIS): immediate needle decompression (14-16 gauge angiocatheter) at 4th-5th intercostal space, anterior or mid-axillary… |
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