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 dyspnea (most common), pleuritic chest pain, cough; Hemoptysis (rare; suggests pulmonary infarction); Syncope or near-syncope (suggests hemodynamically significant PE);… | Sudden unilateral pleuritic pain + decreased breath sounds + hyperresonance in tall, thin young man = primary spontaneous pneumothorax until proven otherwise.; Sudden ipsilateral pleuritic chest pain and dyspnea; PSP often during rest or sleep; may be mild and self-limited; Severe distress in SSP (limited reserve) and tension PTX;… |
| 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 exclude PE in low-probability patients (<15%) without further testing.; D-dimer — sensitive but not specific; useful to rule out PE in low-probability patients (age-adjusted threshold:… | Confirmed by imaging in stable patient. Tension PTX is a CLINICAL diagnosis (hypotension, absent breath sounds, distended neck veins) requiring immediate decompression.; Most cases require no specific labs; obtain ABG/SpO2 to assess oxygenation; Consider underlying disease workup if SSP |
| Imaging | CT pulmonary angiography (CTPA) — gold standard if no contraindication; V/Q scan — alternative if CTPA contraindicated (renal failure, contrast allergy, pregnancy with low CXR yield); Lower extremity Doppler — supportive when PE imaging contraindicated; Echocardiogram — RV dilation/dysfunction, McConnell sign (akinesia of RV mid-free… | Upright PA chest radiograph — visceral pleural line with absent lung markings peripheral to it; Expiratory or lateral decubitus views increase sensitivity for small pneumothoraces; Bedside lung ultrasound — high sensitivity (absent lung sliding, lung point pathognomonic) for trauma/critical care; CT chest — gold standard for… |
| First-line treatment | Anticoagulation while awaiting imaging if high clinical suspicion and low bleeding risk; Hemodynamically stable PE: direct oral anticoagulant (DOAC) preferred — apixaban (10 mg BID × 7 d, then 5 mg BID) or rivaroxaban (15 mg BID × 21 d, then 20 mg daily) — no parenteral lead-in; Alternative: dabigatran or edoxaban (require initial… | Tension pneumothorax (CLINICAL DIAGNOSIS): immediate needle decompression (14-16 gauge angiocatheter) at 4th-5th intercostal space, anterior or mid-axillary line (preferred over the historical 2nd intercostal space midclavicular line per ATLS 10th edition) — followed by definitive tube thoracostomy; Open pneumothorax (sucking chest… |
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