Pneumothorax

Question 1

What is a pneumothorax?

Answer 1

Condition where air gets into the pleural space, separating the lung from the chest wall

Question 2

Name a cause of a pneumothorax

Answer 2

• Spontaneous
• Trauma
• Iatrogenic i.e. due to lung biopsy
• Asthma
• COPD
• CF
• Lung fibrosis/sarcoidosis
• Carcinoma

Question 3

What is the investigation of choice?

Answer 3

Erect chest x-ray

Question 4

1) Name a symptom of a pneumothorax
2) Name a sign of a pneumothorax

Answer 4

1) Dyspnoea, pleuritic chest pain
2) Reduced expansion, hyperresonance to percussion, diminished breath sounds

Question 5

Primary pneumothorax management
1) What is the management if there’s no shortness of breath and less than a 2 cm rim of air on the chest x-ray?
2) If this is not the case, how should it be managed?
2) What is done if this treatment doesn’t work (still SoB and >2cm rim of air on CXR)?

Answer 5

1) Discharge home
2) Aspiration
2) Chest drain

Question 6

Secondary pneumothorax management
1) If the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath, what is the management?
2) If the rim of air is 1-2cm, what should the management be?
3) What should be done if the rim of air is <1cm?

Answer 6

1) Chest drain
2) Aspiration
3) Give oxygen and admit for 24hrs

Question 7

What is a tension pneumothorax?

Answer 7

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

Question 8

What does the increased pressure in a tension pneumothorax cause to happen?

Answer 8

Causes the mediastinum to push across, kinking the big vessels in the mediastinum and causing cardiorespiratory arrest

Question 9

Name a sign of a tension pneumothorax

Answer 9

• Tracheal deviation away from side of the pneumothorax
• Reduced air entry on the affected side
• Increased resonance to percussion on the affected side
• Tachycardia
• Hypotension
• Respiratory distress

Question 10

1) How is it treated?
2) What is done after this?

Answer 10

1) Needle thoracentesis - insert a large bore cannula into the 2nd intercostal space in the midclavicular line
2) Chest drain inserted

Question 11

What is the difference between primary and secondary pneumothorax?

Answer 11

Primary = no underlying lung disease, secondary if there is

Question 12

What is the definitive management of recurrent pneumothorax?

Answer 12

Video assisted thoracoscopy surgery with pleurodesis. Bullectomy can be used alongside