Pneumothorax

Question 1

Describe a pneumothorax

Answer 1

air in the pleural space
=> partial or complete collapse of the affected lung.

Question 2

Describe who normally develops a Primary Spontaneous Pneumothorax (PSP)

Answer 2

• No underlying lung disease
• often tall, thin, young men
• associated with the rupture of subpleural blebs or bullae.

Question 3

Describe who normally develops a Secondary Spontaneous Pneumothorax

Answer 3

• patients with pre-existing lung disease (COPD, asthma, CF, Lung ca, Pneumocystis pneumonia)
• Connective tissue diseases (e.g. Marfan’s) are also a risk factor

Question 4

Describe what is meant by a traumatic pneumothorax

Answer 4

• penetrating or blunt chest trauma
  => lung injury and pleural air accumulation.

Question 5

What could cause an iatrogenic pneumothorax

Answer 5

complication of medical procedures:
- Thoracentesis
- central venous catheter placement
- ventilation (and NIV)
- lung biopsy

Question 6

What happens in a tension pnuemothorax?

Answer 6

severe pneumothorax causing displacement of mediastinal structures

=>severe respiratory distress and haemodynamic collapse.

Question 7

What is a Catamenial pneumothorax?

Answer 7

spontaneous pneumothorax occurring in menstruating women

thought to be caused by endometriosis within the thorax

Question 8

Describe the sudden onset symptoms seen in pneumothorax

Answer 8

dyspnoea
pleuritic chest pain

Question 9

Signs on examination

Answer 9

hyper-resonant lung percussion
reduced breath sounds
reduced lung expansion
tachypnoea
tachycardia
respiratory distress
tracheal deviation away from the side of the pneumothorax
hypotension

Question 10

Management options in pneumothorax

Answer 10

Conservative if minimally symptomatic

Needle aspiration is advised for primary spontaneous pneumothorax if rapid symptom relief required

Tube drainage is recommended for secondary spontaneous pneumothorax

Question 11

What high-risk characteristics would favour insertion of a chest drain as management?

Answer 11

• Haemodynamic compromise (tension pneumothorax)
• Significant hypoxia
• Bilateral pneumothorax
• Underlying lung disease
• ≥ 50 years of age with significant smoking history
• Haemothorax

Question 12

If we opt for conservative management in a spontaneous pneumothorax, how regularly should patients be followed-up?

Answer 12

PSP - review as OP (every 2-4 days)

SSP - monitor as IP
- once stable, review as OP in 2-4 weeks time

Question 13

Patients can be discharged following needle aspiration of a pneumothorax if it is successful. TRUE/FALSE?

Answer 13

TRUE
if successful (i.e. improved symptoms or resolution on CXR)
discharge and review in OP department in 2-4 weeks time.

Question 14

What management should be used if needle aspiration is unsuccessful

Answer 14

Insert chest drain

Question 15

Techniques for pneumothorax prevention

Answer 15

Chemical pleurodesis

Thoracic surgery if recurrence prevention is necessary
- video-assisted thoracoscopic surgery (VATS) to allow for mechanical/chemical pleurodesis +/- bullectomy.

Question 16

What 3 things should be avoided following pneumothorax

Answer 16

• Smoking
• scuba diving
• Flying (Patients may be fit to fly after 2 weeks if no residual air seen on CXR after successful drainage)