Chapter 10: Recognizing Pneumothorax, Pneumomediastinum, Pneumopericardium, and Subcutaneous Emphysema Flashcards

1
Q

How do you recognize a pneumothorax?

A

Visualization of the visceral pleural line

Convex curve of the visceral pleural line paralleling the countour of the chest wall

Absence of lung markings distal to the visceral pleural line

The deep sulcus sign of an inferiority displaced costophrenic angle seen on a supine chest

The presence of an air-fluid interface in the pleural space

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2
Q

How large is the pneumothorax?

A

Size measurement of pneumothorax on X-rays correlate poorly with CT scans of the actual size

There is poor circulation between the size of the pneumothorax and the degree of clinical impairment

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3
Q

What is the 2 cm rule and what disease does it correlate with?

A

Pneumothorax

If the distance between eh lung margin and the chest wall at the apex is <2cm, a chest tube is usually not needed; a distance >2cm usually requires chest tube drainage

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4
Q

What is the most important determinant in deciding whether a patient needs a chest tube?

A

Patient’s clinical status

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5
Q

What is a pneumothorax?

A

Air in the pleural space

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6
Q

What must you identify to diagnose a pneumothorax?

A

The visceral pleural white line

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7
Q

What are the pitfalls that resemble a pneumothorax?

A

Bullae
Skinfolds
Medial border of the scapula

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8
Q

What does a simple pneumothorax have?

A

It doesn’t have a shift of the heart or mobile mediastinal structures

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9
Q

What does a tension pneumothorax create?

A

Produces a shift of the heart and mediastinal structures AWAY from the side of the pneumothorax by virtue of a check-valve mechanism that allows air to enter the visceral pleural space but not leave

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10
Q

What do most pneumothoraces have?

A

Traumatic causes

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11
Q

What imaging is better at estimating the size of a pneumothorax?

A

A CT

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12
Q

What are other ways to diagnose a pneumothorax besides an upright CXR?

A

Expiration exposures
Decubitus views
Delayed images

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13
Q

What test detects a small pneumothorax?

A

CT

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14
Q

Why do spontaneous pneumothoraces occur?

A

They occur as a result of rupture of a small apical, subpleural bleb and they most often occur in younger men

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15
Q

How does a pulmonary interstitial emphysema occur and how are they read on an Xray?

A

Results from an increase in the intraalveolar pressure, which leads to rupture of an alveolus and dissection of air back toward the Hilar along the bronchovascular bundles

It is difficult to see on Xray

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16
Q

When does a pneumomediastinum occur?

A

Occurs when air tracks back to the mediastinum from a ruptured alveolus or from perforation of an air-containing viscus such as the esophagus or trachea

17
Q

What does a pneumomediastinum produce on an X-ray?

A

Produces a continuous diaphragm sign on a frontal chest xray

18
Q

How does a pneumopericardium form?

A

Requires direct penetration of the pericardium to occur rather than dissection of air

19
Q

How do you differentiate a pneumopericardium from a pneumomediastinum?

A

A pneumopericardium does not extend above the roots of teh great vessels, whereas pneumomediastinum does

20
Q

What is subcutaneous emphysema?

A

Air dissecting into the neck and chest wall