Pneumothorax

Question 1

Definition

Answer 1

Otherwise known as a ‘collapsed lung’, occurs when air escapes from the lungs

There is air in the pleural space which leads to partial or full collapse of the lung

Question 2

Epidemiology

Answer 2

Men 6x more likely

Question 3

Aetiology

Answer 3

Can occur spontaneously:
- primary spontaneous (20-30 years):
- risk factors:
— smoking
— tall thin body
— pregnancy
— marfan syndrome
— family history
— Caused by a rupture of a pleural bleb, usually apical (apex), and is thought to be due to congenital defects in the connective tissue of the alveolar walls

• secondary spontaneous (60-65 years)
• associated diseases:
  — COPD
  — asthma
  — HIV with pneumonia
  — tuberculosis
  — sarcoidosis
  — necrotising pneumonia
  — cystic fibrosis
  — thoracic endometriosis
  — inhalation drug use like cocaine or marijuana

Can occur from trauma to the chest wall (traumatic pneumothorax):
– penetrating or blunt trauma
– rib fracture

Iatrogenic pneumothorax (occurs as a result of surgery):
– pleural biopsy
– transbronchial lung biopsy
– central venous catheter insertion
– positive pressure ventilation
– intercostal nerve block

Both lungs are affected with equal frequency

Question 4

Clinical presentation

Answer 4

General signs and symptoms:
– sudden chest pain
—- the chest pain is pleuritic, sharp, severe, and radiates to the ipsilateral shoulder
– shortness of breath

Other symptoms noted on examination:
– respiratory discomfort
– tachypnoea
– hypersonnant percussion note
– decreased intensity of breath sounds or absent breath sounds
– asymmetrical lung expansion

Small pneumothorax:
– small rim of air in pleural space:
—- minimal symptoms

tension pneumothorax:
– reduced breath sounds
– hyperresonant percussion on examination
– tachycardia >134bpm
– hypotension
—- this can lead to reduced venous return putting the pt at risk of a heart attack
– jugular venous distension
– cyanosis
– respiratory failure
– cardiac arrest