Introduction: Chest trauma has a high incidence and pneumothorax is the most frequent finding. The literature is scarce on what to do with asymptomatic patients with pneumothorax due to penetrating chest trauma. The aim of this study was to evaluate what are the findings of the control radiography of patients with penetrating chest trauma who are not initially taken to surgery, and their usefulness in determining the need for further treatment. Methods: A retrospective cohort study was performed, including patients older than 15 years who were admitted for penetrating chest trauma between January 2015 and December 2017 and who did not require initial surgical management. We analyzed the results of chest radiography, the time of its acquisition, and the behavior decided according to the findings in patients initially left under observation. Results: A total of 1,554 patients were included, whose average age was 30 years, 92.5% were male and 97% had a sharp weapon wound. Of these, 186 (51.5%) had no alterations in their initial X-ray, 142 had pneumothorax less than 30% and 33 had pneumothorax greater than 30 %, hemopneumothorax or hemothorax. Closed thoracostomy was required as the final procedure in 78 cases, sternotomy or thoracotomy in 2 cases and discharged in 281. Conclusion: In asymptomatic patients with small or moderate pneumothorax and no other significant lesions, longer observation times, radiographs and closed thoracostomy may be unnecessary.

Focused Assessment with Sonography for Trauma (FAST) has been widely used and studied in blunt and penetrating trauma for the past 3 decades. Prior to FAST, invasive procedures such as diagnostic peritoneal lavage and exploratory laparotomy were commonly used to diagnose intra-abdominal injuries. Today, the FAST examination has evolved into a more comprehensive study of the abdomen, heart, thorax, inferior vena cava, among others, with many variations in technique, protocols and interpretation. Trauma management strategies such as laparotomy, endoscopy, computed tomography angiography, angiographic intervention, serial imaging and clinical observation have also changed over the years. This technique, at times, has managed to replace computed tomography and peritoneal lavage diagnosis, without producing delays in the surgical procedure. As such, the relationship between the patient’s clinical information and the results of the exam should be guided to guide therapeutic approaches in difficult to access settings such as intensive care units in war zones, rural or remote locations where other imaging methods are not available. This review will discuss the evolution of the FAST exam to its current status and evaluate its evolving role in the acute management of the trauma patient.