Pneumothorax

Question 1

What is a pneumothorax and what are the different types?

Answer 1

Air in the pleural space.

Primary spontaneous (otherwise healthy individual)
Secondary spontaneous (underlying lung pathology)
Traumatic
Tension (Causes tracheal deviation away from the pneumothorax)

Question 2

Describe the clinical presentation of a pneumothorax?

Answer 2

Pleuritic pain- unilateral
SOB
Haemoptysis

However it is often asymptomatic 2/3.

Question 3

What is the pathology underlying a tension pneumothorax?

Answer 3

It is a medical emergency as it is causing compression of mediastinal structures, aka the IVC it can therefore stop venous return to the heart causing cardiogenic shock.

Question 4

What are the risk factors for developing a pneumothorax?

Answer 4

Primary pneumothorax:

Tall patients
Marfans
Smoking
Presence of sub pleural blebs

Secondary pneumothorax:

Various underlying lung conditions, including 
-COPD
-tuberculosis
-sarcoidosis
-cystic fibrosis
-malignancy
-idiopathic pulmonary fibrosis.
FH of pneumothoraces

Question 5

What findings would you expect to see o/e?

Answer 5

Tachypnoea
Reduced unilateral chest expansion
Hyperesonance on affected side
Reduced or absent breath sounds on affected side

Question 6

What investigations would you do, and how would you treat an emergency tension pneumothorax?

Answer 6

O2 sats and observations

Bloods: 
FBC
UEs
LFTs
CRP
ABG

Rule out other causes

Imaging:
CXR (shouldn’t wait for this if you suspect a tension pneumothorax)

Question 7

What is the management for a simple pneumothorax?

Answer 7

Primary

• <2cm then can discharge and monitor
• > 2cm then fine needle aspiration and insert chest drain if does not work

Secondary

• always admit
• <1cm then observe with oxygen
• 1-2cm then FNA with chest drain if does not work
• > 2cm chest drain insertion

Question 8

What is pleurectomy and pleurodesis?

Answer 8

It is a key hole thoracic’s surgical procedure in which par of the pleura is removed (pleurectomy) and the lung is attached down to the chest wall.

Pleurodesis is when a sclerosing agent is used to adhere the 2 pleura and eliminate the pleural space

Question 9

What are the indications of pleurectomy and pleurodesis?

Answer 9

2 or more spontaneous pneumothoraces.

A traumatic pneumothorax.

Question 10

What is a tension pneumothorax?

Answer 10

One way valve formation that lets air in but not out again causing compression of the lung and surrounding structures

Question 11

What are signs of a tension pneumothorax?

Answer 11

Tracheal deviation away from affected side
Tachycardia
Hypotension