2.0 Pleural diseases - pneumothorax, mesothelioma Flashcards
What is the definition of pneumothorax
Presence of air within the pleural cavity due to a breach of visceral or parietal pleura with entry of air, lung collapses away from chest wall because of elastic recoil of the lung
A pneumothorax can either be?
spontaneous or traumatic
Define tension pneumothorax
progressive build-up of trapped air within the pleural spaceo the air pressure within the thorax mounts higher than atmospheric pressure - compressing the lung
What is the possible outcome of tension pneumothorax
may displace the mediastinum and its structures (including the lung) toward the opposite side and lead to cardiopulmonary impairment
What believed to be the cause of primary spontaneous pneumothorax
No apparent underlying disease
Believed to be due to weight of lung inducing development of apical blebs that rupture
What is the cause of secondary spontaneous pneumothorax
Pre existing lung disease e.g. COPD, asthma, pneumonia, TB, cystic fibrosis etc
What is an example of a non-iatrogenicTraumatic pneumothorax (not caused by a physician)
Penetration to the chest wall by a gun, knife
or a blunt chest injury
What kind of Iatrogenic procedures can cause a traumatic pneumothorax
(ie due to therapy or by physician)
Pleural aspiration/biopsy
Sub-clavian vein cannulation
Lung, liver, breast, renal biopsy
Acupuncture
When is pneumothorax asymptomatic
if small, good respiratory reserve
What is the symptoms of pneumothorax
Acute breathlessness, worsening breathlessness
Pleuritic chest pain
dyspnoea
What is the signs of pneumothorax - no tension
on the affected side: reduced expansion hyper resonant absent or decreased breath sounds Subcutaneous emphysema
What are the signs of a tension pneumothorax
Trachea deviated away from affected side
Haemodynamic compromise - abnormal heat rhythms
JVP - jugular vien pressure
What is subcutaneous emphysema
trapped air under the skin, giving a bubble wrap appearance
When is a chest drain performed in pneumothorax
Tension pneumothorax
Unsuccessful aspiration
Secondary pneumothorax
Where is a chest drain inserted for a tension pneumothorax and a secondary pneumothorax
Tension - 2nd intercostal space mid-clavicular line
Secondary - 4th intercostal space mid-axillary line
What is the management for a small pneumothorax, no breathlessness
check with a chest X-ray, keep patient overnight and observe, but no treatment is required
review 2 weeks later
When would an aspiration be performed in a pneumothorax
small pneumothorax and patient is breathless
When does aspiration of a pneumothorax stop
when you feel lung surface on the tip of the aspirating tube beneath the surface of the chest wall
or
after no more than 3L of aspiration
What is the difference in management if pneumothorax causes subcutaneous emphysema,
Bigger chest tube is used with the addition of a underwater seal
what is the benefit of the under water seal
prevents backflow of air or fluid into the pleural cavity
How do you check the outcomes of a chest drain and what is the positive outcomes
Check outcome on CXR
Lung inflates in 1-2 days Drain stops bubbling CXR confirms lung inflated
Why would you clamp the drain for 24 hours after the CXR confirms the lungs are inflated
detects small air leaks, avoids re-insertion of chest drains
If lungs fail to inflate with a chest drain, what Investigation can take place after 3 days
thoracoscopic inspection of visceral pleura
When would you refer a patient for surgica/chemical pleurodesis or pleuroectomy
HIGH RISK
second ipsilateral pneumothorax
first contralateral pneumothorax
first pneumothorax in high risk professions (pilots, divers)
What is mesothelioma
Pleural malignancy
What is the main cause of mesothelioma
exposure of asbestos
highly fibrous naturally occuring mineral woven into fabric
What is the three main types of asbestos
What type of asbestos is worse for your health
Chrysotile (white)
Amosite (brown)
Crocidolite (blue) -this one is worse for your health
What is the clinical presentations of mesothelioma
Breathlessness
Chest wall pain
what shows on the radiology of mesothelioma
Diffuse or localised pleural thickening
Is mesothelioma usually bilateral or unilateral
unilateral
What is the main factors to consider in the treatment of pneumothorax
Is it tension
the size of the pneumothorax (>2cm)
Is patient breathless
Primary or secondary pneumothorax
