Iatrogenic pneumothorax is a serious concern for any medical centre performing invasive procedures. While often preventable, it remains one of the most common causes of procedure-related pneumothorax—and is frequently cited in malpractice claims. Without prompt diagnosis and treatment, life-threatening complications can occur. In recognition of World Pneumothorax Day (June 24), this article explores the prevalence of iatrogenic pneumothorax in 2025—and why clear assessment of line and tube placement remains essential for early detection and risk reduction.
What Is Iatrogenic Pneumothorax?
Iatrogenic pneumothorax is a type of pneumothorax (where air escapes into the pleural space and may compress the lung or cause more serious cardiovascular effects) that is caused unintentionally during a medical procedure. Air enters the pleural space often due to lung puncture and a breach in the pleura (the lining around the lungs). Diagnosis is made through physical examination and using a chest X-ray or CT scan.
Iatrogenic Pneumothorax: Causes and Trends in 2025
Iatrogenic pneumothorax can happen during various procedures, especially those involving the lungs or chest. It is commonly triggered by:
- Subclavian central venous line placement
- Pulmonary needle biopsy
- Central venous catheter placement
- Nasogastric tube placement
- Breathing machines with positive pressure
Over the past several decades, studies have shown that iatrogenic pneumothorax remains a clinically significant and preventable cause of morbidity in hospital settings. Although it does not represent the majority of all pneumothorax cases—spontaneous and traumatic types are also common—it is a frequent complication of specific medical procedures, particularly in critical care environments. For example, iatrogenic causes accounted for approximately 95% of tension pneumothorax cases in one recent study, most often linked to mechanical ventilation and central venous catheter placement.
A prospective ICU study involving 3,430 patients reported an iatrogenic pneumothorax rate of 3% over 30 days, highlighting the risks associated with invasive care. More broadly, U.S. hospital discharge data estimate an overall incidence of 5 to 7 iatrogenic pneumothoraces per 10,000 admissions, a figure that has remained relatively stable over time despite procedural advances.
Analyses from the American Society of Anesthesiologists (ASA) Closed Claims Project, which examines anesthesia-related malpractice cases, found that pneumothorax accounted for about 3% of all respiratory-related claims in their database, with most cases related to procedures like needle puncture or barotrauma from airway management.
This underscores the ongoing risk posed by iatrogenic pneumothorax to healthcare providers and highlights the need for preventive strategies such as careful line placement, use of real-time imaging guidance, and prompt post-procedure checks.
Why It Still Matters to Hospitals
Despite years of medical innovations, iatrogenic pneumothorax continues to be a persistent problem for healthcare providers across the world, including Canada and the United States. It is an issue that hospitals must proactively address, considering the direct impact it has on patient safety and hospital workflow.
Patient Outcomes
Pneumothorax poses a significant threat to patient health and quality of care while in the hospital. If not quickly diagnosed and managed, it can cause respiratory failure and cardiovascular instability. It is important that incidents of iatrogenic pneumothorax be avoided at all costs, especially when dealing with vulnerable patient populations, such as patients in critical care. Those who are already at-risk can have their condition exacerbated by pneumothorax.
Risk of Medical Malpractice
When iatrogenic pneumothorax occurs, the hospital is exposed to significant legal liability. As seen in the statistical breakdown, this condition is already commonly associated with medical malpractice claims. Patients and their families may hold the hospital accountable for any complications resulting from iatrogenic pneumothorax, including incidents of death.
Strain on Hospital Resources
In emergency hospital settings, resource usage and patient care costs are a major consideration, especially when resource availability is a problem. Iatrogenic pneumothorax prolongs hospital stays and necessitates the increased usage of hospital resources that contribute to the overall cost of care.
Innovation Spotlight: Reveal 35C
Quick diagnosis is crucial for preventing serious complications from iatrogenic pneumothorax. Imaging technologies are crucial to not just diagnosis, but also visualization of lines and tubes (such as central venous catheter, nasogastric tubes.etc) that can puncture the lung. Clinical studies using the Reveal 35C detector with SpectralDR® technology have demonstrated improved visualization of lines and tube tips with no added reading time.
Dual-Energy X-ray Detector for Medical Lines and Tubes
Reveal 35C takes an innovative approach to dual-energy X-ray with retrofittable capabilities. On a conventional X-ray system, Reveal 35C can generate 3 images in a single exposure: a traditional DR image, soft tissue image, and bone image.
With SpectralDR phase contrast, the bone image can highlight the appearance of line and tube tips, which can help radiologists better determine whether they were correctly placed. Thanks to its portability, it can take high-quality dual-energy X-ray images from the bedside to assess line and tube placement, as well as the patient’s clinical progress. Making Reveal 35C a part of your workflow can assist with the early identification of iatrogenic pneumothorax, and potentially prevent the serious consequences associated with late diagnosis.