Pneumothorax Flashcards
Pneumothorax definition
Presence of air in the pleural cavity with partial or total collapse of lung
3 main types of pneumothorax
Spontaneous
Traumatic
Iatrogenic
What is primary spontaneous pneumothorax
Pneumothorax that occurs without precipitating event in a person does not have known lung dx
Main location of rupture in primary spontaneous pneumothorax
Rupture of subpleural blebs especially at the apices of lungs
Main population at risk of PSP
Young male with tall and thin aesthenic physic
Pathophysiology of spontaneous pneumothorax
From expansion of alveoli beneath pleura
Leading to rupture of alveolar walls and overlying pleura
What is the mechanism of tension pneumothorax
Valve like mechanism where air enters during inspiration but cannot leave during expiration
Tension build sup
X ray findings of tension pneumothorax
Partial or complete collapse of lung towards hilum
Increased translucency
Absence of lung markings in greater part of i psi lateral hemithorax
Mediastinal shift to contralateral side
Ipsilateral diaphragmatic depression
Ipsilateral increase in intercostal spaces
Increased vascularity of contralateral lung
Secondary spontaneous pneumothorax causes
COPD
Pulmonary tuberculosis
Enterogenous cyst
RDS of newborn
Pulmonary neoplasm
Bullous lung dx
What is traumatic pneumothorax
Caused by penetrating or blunt trauma to chest with air entering pleural space
Different ways air enter pleural space in traumatic pneumothorax
Directly through chest wall
Through visceral pleural penetration
Through Alveolar rupture resulting from sudden chest compression
Which type of pleural effusion is often associated with traumatic pneumothorax
Hemothorax
Event leading to haemo -pneumothorax
Rib fractures
Penetrating chest wound
Perforating chest wounds
Surgical procedures in chest cavity including oesophagus
Definition of iatrogenic pneumothorax
Pneumothorax after Complication of diagnostic or therapeutic intervention
Main causes of iatrogenic pneumothorax
Subclavian percutaneous catheterisation (central lines, pacemaker insertion )
Transthoracic lung biopsies
Trans bronchial lung biopsies
Thoracocentesis
Chest tube malfunction
Population at risk of catamenial pneumothorax
Women 30-40 yo
What is catamenial pneumothorax
Cyclical chest pain from presence of endometrial tissue in pleural space
what do the symptoms start in catamenial pneumothorax
Within 48h of menstruation
Main symptoms in catamenial pneumothorax
Right sided chest pain
Shortness of breath
Conditions associated with catamenial pneumothorax
Endometriosis
Infertility
What is persistent pneumothorax
Continued air leak from an in situ chest drain more tan 48h after insertion
Main causes of persistent pneumothorax
Kinking of the tube
Malposition of tube
Lung parenchymal tube
Bronchopleural fistula
Oesophageal pleural fistula
Consequence of pneumothorax in healthy lungs
Partial or total collapse of lung
Minimal arterial hypoxemia
Diminished exercise tolerance
Consequence of tension pneumothorax
Mediastinal shift to contralateral side
Compression of lung
Impairment of venous return to heart and severe ventilation perfusion defect
When can pneumothorax result in acute respiratory failure
Obstructive airway
Severe pulmonary dx
History of pneumothorax
Chest pain - sharp, stabbing, on the side of chest involved
Dyspnea with cyanosis , sweating. Faintness
Respiratory Examination findings in pneumothorax
Respiratory distress
Tachypnoea
Asymmetric lung expansion
Mediastinal and tracheal shift (tension pneumothorax )
Distant / absent breath sounds
Hyperresonance
Decreased tactile fremitus
Adventitious lung sounds (crackles , wheeze)
Cardiovascular exam findings
Pulsus paradoxus
Hypotension
JVD
Cardiac apical displacement
Tachycardia
Investigation
Chest xray
Ct scan
Treatment of small pneumothorax
If less than 1.5cm, no distress of patient -> Allow spontaneous reabsorption
With serial xray to follow progression
Heimlich valve with one way disposable one way valve for self limiting pneumothorax
Treatment tension pneumothorax
Wide bore intercostal catheter connected to underwater seal and suction
Done in 2nd intercostal space anterior , mid clavicular line
Function of treatment with chemical pleurodesis
Achieve adhesion between parietal and visceral layer of pleura
Chemical used in chemical pleurodesis for adhesion of parietal and visceral pleural layers
10% silver nitrate
Iodized talc powder
50% glucose though thoracospe into pleural space
Bleomycin in malignancies
Indication for surgery in pneumothorax
Persisten air leak
2nd recurrence
Contralateral pneumonectomy
Contralateral diseased lung
Specialized occupation - pilot , deep sea diver
Remote from reasonable medical care
Contraindications to VATS
Chronic pneumothorax with restrictive membrane over visceral pleural that can interfere with full re expansion of lung
