Pneumothorax

Question 1

Define pneumothorax

Answer 1

Air in the pleural space separating the lung from the chest wall

Question 2

Typical pneumothorax patient

Answer 2

Tall, thin young man presenting with sudden breathlessness and pleuritic chest pain, possibly whilst playing sports

Question 3

Causes of pneumothorax

Answer 3

Spontaneous

Trauma

Iatrogenic such as due to lung biopsy, mechanical ventilation or central line insertion

Lung pathology such as infection, asthma or COPD

Question 4

Investigations in pneumothorax

Answer 4

Erect CXR

CT thorax can detect pneumothorax that is too small to be seen on CXR

Question 5

Management of pneumothorax

Answer 5

No SOB and <2cm rim of air on CXR: no treatment required - follow up in 2-4 weeks

SOB and/or >2cm rim of air on CXR: aspiration and reassessment

If aspiration fails twice: chest drain

Unstable patients or bilateral or secondary pneumothoraces generally require a chest drain

Question 6

What is a tension pneumothorax?

Answer 6

Caused by trauma to chest wall that creates a one-way valve that lets air in but not out of the pleural space

Question 7

Signs of tension pneumothorax

Answer 7

Tracheal deviation away from side of pneumothorax

Reduced air entry to affected side

Increased resonant to percussion on affected side

Tachycardia

Hypotension

Question 8

Management of tension pneumothorax

Answer 8

Insert a large bore cannula into the second intercostal space in the mid-clavicular line

Once pressure relieved insert chest drain

Question 9

Chest drain triangle of safety

Answer 9

5th intercostal space (or the inferior nipple line)

Mid axillary line (or the lateral edge of the latissimus dorsi)

Anterior axillary line (or the lateral edge of the pectoris major)