PNEUMOTHORAX

Question 1

History and Physical

Answer 1

Acute onset pleuritic chest pain and shortness of breath

May become dull and constant

Tachycardia - most common exam finding

Decreased ipsilateral breath sounds

Hyperesonance to percussion

Question 2

Investigations

Answer 2

PA CXR - primary diagnostic modality

No clear benefit for expiratory film

Deep sulcus sign

US - sn 98%, sp 99%

Question 3

Management & Disposition
Traumatic
Primary Spontaneous
Secondary Spontaneous

Answer 3

Traumatic:
Chest tube in all patients unless occult or small and asymptomatic with no concern for hemothorax

Small (< 3 cm) Primary Spontaneous, minimal symptoms:
NRB
Repeat CXR in 3-6 hours

Large (>/ 3 cm) Primary Spontaneous:
Aspiration
OR
Chest tube

Small (<3 cm) Secondary Spontaneous:
Aspiration
OR
Chest tube

Large (>/ 3 cm) Secondary Spontaneous:
Chest tube