Pneumothorax

Question 1

What is a pneumothorax?

Answer 1

Air in the pleural space

Question 2

How can the causes of pneumothorax be classified? Give examples

Answer 2

Primary (spontaneous) or

Secondary to:

• Trauma
• Medical interventions (iatrogenic)
• Lung pathology

Question 3

Give three examples of medical procedures which can cause a pneumothorax

Answer 3

• Lung biopsy
• Mechanical ventilation
• Central line insertion

Question 4

Give three examples of lung pathology which can cause a pneumothorax

Answer 4

• Asthma
• COPD
• Infection

Question 5

Smoking increases the risk of pneumothorax. True or false?

Answer 5

True

Question 6

What is the diagnostic investigation for pneumothorax?

Answer 6

(Erect) CXR

Question 7

How do you measure a pneumothorax on a CXR?

Answer 7

Measure horizontally from the lung edge to the inside of the chest wall at the level of the hilum

Question 8

How would you manage a primary pneumothorax?

How would you manage a secondary pneumothorax?

Answer 8

Primary:

• If patient is NOT SOB and rim of air is < 2 cm in size, then discharge
• Otherwise, aspirate

Secondary:

• If patient is NOT SOB and rim of air is < 1 cm, admit and observe
• If 1-2 cm, aspirate
• If > 2 cm, chest drain

Question 9

If a pneumothorax is managed conservatively how is the patient followed up?

Answer 9

Repeat CXR in 2-4 weeks to check for resolution of pneumothorax

Question 10

What is a tension pneumothorax?

Answer 10

A type of pneumothorax caused by trauma to the chest wall which creates a one-way valve that lets air in but not out of the pleural space

Question 11

What is the characteristic sign of a tension pneumothorax?

Answer 11

Tracheal deviation AWAY from the affected side

Question 12

How do you manage a tension pneumothorax?

Answer 12

Needle thoracostomy:

- Insertion of a large bore cannula into the second intercostal space in the midclavicular line

Question 13

Where is a chest drain inserted?

Answer 13

Chest drains are inserted into the “triangle of safety”, which is formed by:

• 5th intercostal space
• Mid-axillary line (lateral edge of latissimus dorsi)
• Anterior axillary line (lateral edge of pectoris major)

Question 14

When inserting a chest drain, is the needle inserted just above or just below the rib? Why is this?

Answer 14

Just above the rib to avoid the neurovascular bundle that runs just below the rib