Evaluation of thoracic wall thickness with computed tomography and its relation with demographic data

Objective:Tension pneumothorax is one of life-threatening injuries. Needle decompression is recommended from the second midclavicular intercostal space. Additionally, for this process, different anatomical regions is also suggested in some studies. There are some situations where this vital process has failed.An example of this is the fact that patients have different chest wall diameters but the same catheter is applied to the patient. The aim of this study is to evaluate the thoracic wall thickness with computerized tomography (CT) and to determine which anatomical region should be selected for a successful procedure. Matherial and Methods:The147 patients who applied to Ankara Yildirim Beyazit University Ataturk Research and Training Hospital Emergency Department were recruited to this study. Sociodemographic data and body mass index (BMI) of these patients who underwent thorax CT for any reason were recorded. Patients' right/left second intercostal midclavicular and fifth intercostal midaxillary and anterior axillary thoracic wall thickness measurements were calculated separately. Results:Of the 147 patients recruited to this study, 61.9% were male, 38.1% were female and mean age was 57 and BMI median was 25.47. Thoracic wall thicknesses were calculated as 27.2 mm on the rightside and 27.3 mm on the left side of second intercostal midclavicular (MC) space. The fifth intercostal space was 43.5 mm on the right side and 43.8 mm on the left midaxillary (MA) line. The fifth intercostal space was measured as 32.2 mm on the anterior axillar (AA) line and 31.2 mm on the left. It is shown that there is a stepwise increase in thoracic wall thickness related to increasing BMI. It is also founded that needle thoracostomy with standard 5 cm catheters would be expected to fail in 12.9% of patients in the second MC intercostal space compared with 67.4% at the fifth MA intercostal space and 27.2% at the fifth AA intercostal space. Conclusion:According to the results of our study, 5 cm catheter which is used classically in tension pneumothorax cases has higher success rates than the fifth intercostal space when applied from the second intercostal space. This study suggests the classical second MC intercostal space for needle decompression procedure. It should be noted that the thickness of the thorax wall increases in proportion to the BMI, which may lead to a failure of the procedure.