Pneumothorax Flashcards
What is pleura
lining of the lung
What is visceral and parietal pleura
visceral- forms the
outer covering of the lung
Parietal- inner lining of chest wall
Purpose of pleura
- Allows for optimal expansion and contraction of the
lungs - Pleural fluid allows for visceral and parietal pleurae to glide over without friction during respiration
What is pneumothorax
’ collapse of lung ‘
- presence of air in pleural space
Pathophysiology of pneumothorax
- air enterns due to either hole in lung/pleura or chest wall injury
- intrapleural pressure is negative, leads to air being sucked into cavity
- can lead to partial or total lung collapse
Different types of pneumothorax
- primary spontaneous pneumothorax
- secondary spontaneous pneumothorax
- traumatic pneumothorax
- large pneumothorax
Common presentation of primary spontaneous
A young, tall, healthy, male presents with sudden onset breathlessness and chest pain
Pathogenesis of primary spontaneous
Spontaneous rupture of a subpleural bleb
RF for primary spontaeous
Tall, slender, young (aged 20-30)
Smoking
Marfan syndrome
Rheumatoid arthritis
Family history
Homocystinuria
Diving or flying
Is there known lung disease in primary spontaneous
no
typical presentation of secondary spontaneous
A middle-aged patient with COPD presents with sudden onset breathlessness and chest pain
Presence of underlying lung disease in secondary spontaneous?
Yes: occurs due to ruptured bleb or bullae secondary to lung disease
Pathogenesis of secondary spontaneous
Rupture of damaged pulmonary tissue
RF for secondary spontaneous
Underlying lung disease: COPD, asthma, lung cancer
Tuberculosis
Pneumocystis jirovecii
Traumatic causes of a pneumothorax?
- Penetrating chest wall injury
- Puncture from rib
- Rupture bronchus/oesophagus
Iatrogenic causes of pneumothorax
‘Doctor induced’
Risk
Pacemakers,
CT lung biopsies,
Central line insertion
Mechanic ventilation
Pleural aspiration
What occurs in a tension pneumothorax
- Air is forced to enter the thoracic cavity without any means of escape, resulting in a ‘one-way-valve’
Symptoms of pneumthorax
- sudden onset pleuritic chest pain
- sudden onset dyspnoea
- sweating - may be present
signs of pneumothorax
- tachycardia and tachypnoea
- cyanosus
- hyperresonance ipsilaterally
- reduced breath sounds ipsilaterally
- ## hyperexpansion ipsilaterally
Investigations of PNM
- CXR- first line
- CT CHEST- GS
What would a CXR show
- tension pneumothorax , mediastinal shift and tracheal deviation contralterally
Management of PNM
- Aspiration is usually performed at the 2nd intercostal space midclavicular line on the affected side, whereas a chest drain is inserted at the 5th intercostal space mid-axillary line on the affected side within the ‘triangle of safety’ alongside high-flow oxygen, with a repeat CXR being performed
Overview of management for pnm
No intervention
-Reabsorb spontaneously 2% volume a day
Consider high flow oxygen (10L)
Pleural Aspiration
-Up to 1.5Litre of air can be aspirated
Chest Drain
-Needed for most secondary pneumothoraxes
Surgery
-For persistent and recurrent pneumothorax
Conservative measures for pnm
- Stop Smoking
- No Air flight until 6 week after resolution
- No Scuba diving (EVER!)
