Pneumothorax

Question 1

Definition of pneumothorax.

Answer 1

A pneumothorax is defined as air within the pleural space.

Question 2

What are the two ways in which pneumothorax is classified?

Answer 2

spontaneous
traumatic

Question 3

what are the causes of spontaneous pneumothorax?

Answer 3

Spontaneous causes can be further classified into primary causes (no underlying lung pathology - typically tall thin young men) and secondary causes (underlying lung pathology).

Question 4

what are some secondary causes of spontaneous pneumothorax?

Answer 4

Secondary causes include connective tissue disease (such as Marfan’s syndrome and Ehlers-Danlos syndrome), obstructive lung disease (such as asthma and COPD), infective lung disease (such as TB and pneumonia), fibrotic lung disease (such as cystic fibrosis and idiopathic pulmonary fibrosis), and neoplastic disease (such as bronchial carcinoma).

Question 5

what are the causes of traumatic pneumothorax?

Answer 5

Traumatic causes can be further classified into iatrogenic causes (such as insertion of a central line or positive pressure ventilation) and non-iatrogenic causes (either a penetrating trauma or blunt trauma with rib fracture).

Question 6

what are symptoms of a pneumothorax?

Answer 6

Symptoms of a pneumothorax include sudden-onset shortness of breath and pleuritic chest pain.

It is important to note in the history whether there are any risk factors for a spontaneous primary pneumothorax (tall and thin young male, smoker), spontaneous secondary pneumothorax (COPD, asthma, Marfan’s syndrome), or traumatic pneumothorax (recent chest trauma, recent invasive medical procedure).

Question 7

signs of a pneumothorax

Answer 7

-tachypnoeic and respiratory distress.
-reduced chest expansion on affected side.
-hyper resonant percussion note on affected side/
-reduced or absent breath sounds on affected side.
-vocal resonance is reduced on affected side.

Question 8

what are some additional signs seen in a tension pneumothorax?

Answer 8

signs of haemodynamic compromise (tachycardia and hypotension) and tracheal deviation to the contralateral side.

Question 9

investigations

Answer 9

CXR

Question 10

management of tension pneumothorax

Answer 10

• High flow oxygen (15 L/min) via a non-rebreather mask should be administered.
• Emergency management is with immediate needle decompression using a 16-gauge cannula inserted at the second intercostal space, mid-clavicular line, on the affected side.
• Note that the needle should be inserted just above the third rib, to avoid damaging the neurovascular bundle. The needle decompression acts as a bridge before insertion of an intercostal chest drain.