pneumothorax

Question 1

what is pneumothorax?

Answer 1

accumulation of air in pleural space with secondary lung collapse

Question 2

what is a closed pneumothorax?

Answer 2

intact chest wall and air leaks from lung into
pleural cavity.

Question 3

what is an open pneumothorax?

Answer 3

defect in the chest wall allows communication
between PTX and exterior: may be sucking.

Question 4

what is a tension pneumothorax?

Answer 4

air enters pleural cavity through one-way valve
and cannot escape → mediastinal compression.

Question 5

what are the causes of a spontaneous primary pneumothorax?

Answer 5

no underlying lung disease
young thin men- ruptured subpleural bulla
smokers

Question 6

what is the cause of spontaneous secondary pneumothorax?

Answer 6

underlying lung disease
COPD
Marfans, ehlers danlos
pulmonary fibrosis, sarcoidosis

Question 7

what are trauma causes of pneumothorax?

Answer 7

penetrating injury
blunt +/- rib fractures

Question 8

what are iatrogenic causes of pneumothorax?

Answer 8

subclavian CVP line insertion
positive pressure ventilation
transbronchial biopsy
liver biopsy

Question 9

what are clinical signs of pneumothorax?

Answer 9

Chest
 reduced expansion
 Resonant percussion
 reduced breath sounds

Tension:
↑JVP
mediastinal shift AWAY from ptx
↑HR, ↓BP

Crepitus:
surgical emphysema

Question 10

what is the management of tension pneumothorax?

Answer 10

clinical diagnosis
urgent needle decompression- large bore venflon into 2nd ICS mid-clavicular line
insert chest drain

Question 11

what is the management of traumatic pneumothorax?

Answer 11

analgesia
2-sided wet dressing if sucking
insert chest drain

Question 12

what is the management of primary pneumothorax?

Answer 12

if SOB +/- rim >2cm (50% vol loss) -> aspiration -> if not successful consider chest drain

if no SOB and <2cm-> consider discharge

Question 13

what is the management of secondary pneumothorax?

Answer 13

if SOB and >50yo + rim>2cm -> chest drain

if not then aspiration + admit for 24 hours. if unsuccessful (ptx >1cm) -> chest drain

if ptx <2cm- admit for 24 hrs and supplemental oxygen

Question 14

what are recommendations for iatrogenic ptx?

Answer 14

less likelihood of recurrence than spontaneous pneumothorax
majority will resolve with observation

if treatment is required -> apsiration

ventilated patients or COPD -> chest drain

Question 15

what is the management of persistent or recurrent pneumothorax?

Answer 15

video-assisted thoracoscopic surgery (VATS) to allow for mechanical/chemical pleurodesis +/- bullectomy.

Question 16

what is discharge advice for pneumothorax?

Answer 16

Smoking cessation

Fitness to fly- contraindicated. CAA- travel 2 weeks after successful drainage if no residual air. BTS -1 wek post CXR check

Scuba diving- permanently avoided unless patient has undergone bilateral surgical pleurectomy + has normal lung function + chest CT scan postoperatively