L5: Pneumothorax & Pleurisy Flashcards
Def of Pneumothorax
- It’s an abnormal collection of air in the pleural space.
Normally, there is no air in the pleural space.
Types of Pneumothorax
Types of Pneumothorax
- 1ry
Occurs in children without known lung disease.
Types of Pneumothorax
- 2ry
Occurs as a complication of chronic or acute lung disease.
Types of Pneumothorax
- Traumatic
Types of Pneumothorax
- Iatrogenic
- Caused by blunt or penetrating trauma to the chest.
- Penetrating trauma → open or communicating pneumothorax
Pathophysiology of Pneumothorax
- Occurs as a complication of certain diagnostic or therapeutic procedures such as central line placement or ventilation
Pathophysiology of Pneumothorax
- Simple Pneumothorax
- The air in the pleural space does allow the lung to collapse.
- It may be asymptomatic.
Pathophysiology of Pneumothorax
- Complicated Pneumothorax
Tension Pneumothorax
- Def
- Pathology
- Complications
- TTT
Etiology of Pneumothorax
Etiology of Pneumothorax
- Traumatic
- Blunt trauma
- Penetrating trauma
Etiology of Pneumothorax
- Iatrogenic
- Central venous line
- Mechanical ventilation
- Intubation
- Transbronchial biopsy
- Bronchoscopy
Etiology of Pneumothorax
- Malformations
Lymphangiomatosis
Etiology of Pneumothorax
- Spontaneous
- Familial
- Idiopathic
Etiology of Pneumothorax
- Infections
- TB
- Measles
- Staph. aureus
- P. carinii
- Echinococcal cyst
Etiology of Pneumothorax
- Inhalation of Toxins
- Caustic fumes
- Cocaine smoking
- Hydrocarbon inhalation
Etiology of Pneumothorax
- Congenital
Marfan syndrome
Etiology of Pneumothorax
- Others
- FB aspiration
- Asthma
- Cystic fibrosis
- Tumor
CP of Pneumothorax
CP of Pneumothorax
- Symptoms
Symptoms of Pneumothorax
- Sudden Chest Pain
Symptoms of Pneumothorax
- RD
Tachypnea - dyspnea - cyanosis
Signs of Pneumothorax
Signs of Pneumothorax
- Inspection
Signs of Pneumothorax
- Palpation
Hyperresonance of affected side
Signs of Pneumothorax
- Percusiion
- Trachea shifted to the opposite side In tension pneumothorax
- Decreased TVF “Tactile Vocal Fremitus”
Signs of Pneumothorax
- Auscultation
- Decreased intensity of breath sounds, transmission of voice, thoracic excursion
DDx of Pneumothorax
- Bronchogenic cyst
- Cystic adenomatoid malformation
- Diaphragmatic hernia
Complications of Pneumothorax
INVx for Pneumothorax
INVx for Pneumothorax
- Rads
Rads in Pneumothorax
- Chest X-Ray
Rads in Pneumothorax
- CT
Can detect the cause
Labs in Pneumothorax
Labs in Pneumothorax
- ABG
Detect increased alveolar-arterial oxygen gradient
Labs in Pneumothorax
- Pulse Oximetry
Detect hemoglobin desaturation
Labs in Pneumothorax
- ECG
Detect changes in the amplitude of QRS complex & the cardiac axis
- “In cases of severe tension pneumothorax with mediastinal shift”
TTT of Pneumothorax
The lungs should be allowed to re-expand slowly, ………
Because rapid re-expansion after evacuation of large collections of air can result in pulmonary edema
- Thus, if pneumothorax is large, it may be best not to apply – pressure immediately.
Suction should be maintained until ……
- It becomes evident that no air is exiting the thoracic cavity then suction can be discontinued and the tube allowed to remain under water seal
If no air leak is evident after 24 hours, …..
the chest tube can be removed.
Tension pneumothorax is a clinical diagnosis and a medical emergency requiring immediate chest decompression
….
Types of Pleurisy
- Dry or Plastic pleurisy
- Serosanguineous or serofibrinous Pleurisy
- Purulent Pleurisy “Empyema”
Cause of Dry / Plastic Pleurisy
- Acute infection “bacteria - virus”
- Acute upper resp. tract illness
- TB
- CT diseases as Rheumatic fever
Pathogenesis of Dry / Plastic Pleurisy
- Limited to visceral pleura
- Small amount of yellow serous fluid
CP of Dry / Plastic Pleurisy
- Pain “Main symptom”
- Grunting
- Pleural rub
Causes of Serosanguineous or serofibrinous
Pleurisy
- infections
- Inflammatory conditions of abdomen
- Tumor
- SLE - Rheumatoid arthritis
Pathogenesis of Serosanguineous or serofibrinous
Pleurisy
- Imbalance () hydrostatic & oncotic pressure
- Permeability of microvascular drainage
- Obstruction of lymphatic drainage
Causes of Purulent Pleurisy
“Empyema”
Pathogenesis of Purulent Pleurisy
“Empyema”
Accumulation of pus in plural space
