Disorders of the chest wall Flashcards
Epidemiology of spontaneous pneumothorax?
More common in tall, thin, young men (20–40 years) & in smokers
What are the causes of spontaneous pnemothorax?
Idiopathic (rupture of apical subpleural bleb)
COPD
Marfan syndrome
Scuba diving
Subclavian catheter insertion
Pathogenesis of spontaneous pneumothorax?
Rupture of subpleural bleb → Hole in pleura
Pleural cavity pressure = Atmospheric pressure → Loss of -ve pressure
Lung partially or completely collapses.
What are the clinical findings and physical exam features of spontaneous pneumothorax?
Sudden dyspnea, pleuritic chest pain
Tympanic percussion note, absent breath sounds, tracheal deviation towards the collapse.
What is the imaging finding of spontaneous pneumothorax?
White visceral pleural line with absent vessel markings peripheral to it.
Tx of spontaneous pneumothorax
Observation for <15% pneumothorax or asymptomatic cases.
100% oxygen to reduce nitrogen partial pressure.
Chest tube insertion or thoracoscopy for larger cases
What is the primary cause of tension pneumothorax?
Penetrating trauma to the lung.
Pathogenesis of tension pneumothorax
Flap-like pleural tear → Air enters pleural cavity but cannot exit.
Increased pressure → Compression atelectasis & compromised venous return.
What is the emergency treatment for tension pneumothorax?
Needle decompression at the 2nd intercostal space, midclavicular line.
Chest tube insertion.
What are the causes of mediastinitis?
Cardiovascular surgeries.
Esophageal or tracheo-bronchial perforation.
Descending infections from the head and neck.
Inflammation of connective tissue that involves mediastinal structures & fills inter-pleural spaces
Mediastinitis
What are the causes of mediastinitis?
Cardiovascular surgeries.
Esophageal or tracheo-bronchial perforation.
Descending infections from the head and neck.
What are the symptoms of mediastinitis?
Severe chest pain, dyspnea, and fever.
What are the causes of esophageal perforation?
Complication of esophagoscopy or insertion of a Sengstaken-Blakemore or
Minnesota tube (for esophageal variceal bleeding)
- Forceful vomiting (Boerhaave syndrome)
- Swallow of caustic substances (e.g. lye solution)
- Certain pills or esophageal ulcers
What is the treatment for esophageal perforation?
Parenteral antibiotics (e.g., clindamycin, ceftriaxone).
Surgical repair of esophageal tear and drainage of pleural and mediastinal spaces.
Wound drainage or sepsis is the clinical presentation of
Median Sternotomy
Diagnosis of Median Sternotomy
Presence of infected fluid in the needle aspirate
TX of Median Sternotomy
Surgical drainage, debridement, parenteral broad-spectrum antibiotics
Causes of chronic fibrosing mediastinitis
Tbc, Histoplasmosis, Sarcoidosis, Silicosis
Pathogenesis of chronic fibrosing mediastinitis
Development of an intense fibrotic process
→ Compression of mediastinal structures → SVC Syndrome or →Tracheal narrowing or → Obstruction of the pulmonary arteries or veins
TX of chronic fibrosing mediastinitis
Tbc cases: Anti-Tbc therapy Otherwise, insertion of vascular or airway stents
What are the types and causes of pneumomediastinum?
Spontaneous or Secondary (blunt trauma, procedures, or hollow organ perforation).
What are the clinical features of pneumomediastinum?
Retrosternal/pleuritic chest pain.
Subcutaneous emphysema.
Dyspnea, cough, fever, dysphagia, & Hamman sign (systolic crackles along left sternal border).
What imaging finding is characteristic of pneumomediastinum?
A double line outlining the mediastinum on chest X-ray.
