Management of Pneumothorax

Question 1

What is pneumothorax?

Answer 1

Presence of air in the pleural space

Question 2

How does pneumothorax occur and what are the corresponding types called?

Answer 2

Can occur spontaneously in healthy people (primary spontaneous pneumothorax)

Can occur spontaneously in patients with pre-existing lung disease (secondary spontaneous pneumothorax)

Question 3

Other than spontaneously, how can pneumothoraces be caused?

Answer 3

Iatrogenic injury

Trauma to lung or chest wall

Question 4

What does management of pneumothorax depend on?

Answer 4

Size of pneumothorax
Clinical symptoms
Underlying lung disease

Question 5

How is size of pneumothorax categorised and defined?

Answer 5

Small or Large
- depends on the size of the visible rim of air between the lung margin and the chest wall

Small <2cm
Large ≥2cm

Question 6

How are small, closed, mildly symptomatic primary spontaneous pneumothoraces managed?

Answer 6

Observation without intervention

- no hospital admission required

Question 7

How are asymptomatic small secondary pneumothoraces managed?

Answer 7

Admission to hospital for observation only

Question 8

How are all primary pneumothoraces and mildly symptomatic small (<2cm) secondary pneumothoraces managed?

Answer 8

First-line is simple aspiration

Question 9

When is intercostal tube drainage indicated?

Answer 9

First-line in moderately/severely symptomatic secondary pneumothoraces (as may cause respiratory failure)

Also used if simple aspiration fails to control symptoms in any pneumothorax

Question 10

When is pleurodesis considered?

Answer 10

To prevent recurrence in primary/secondary spontaneous pneumothorax