Pneumothorax

Question 1

What are the causes of a pneumothorax? (4)

Answer 1

Spontaneous
Trauma
• Iatrogenic such as due to lung biopsy, mechanical ventilation or central line insertion
• Lung pathology such as infection, asthma or COPD

Question 2

What is the best investigation for pneumothorax?

Answer 2

Erect chest xray

Question 3

What is seen on a chest X-ray in pneumothorax?

Answer 3

Area between lung and chest wall with no lung markings
Line demarcating edge of lung

Question 4

Where do you measure size of pneumothorax on a chest x ray?

Answer 4

Horizontally from lung edge to inside of chest wall at level of hilum

Question 5

What investigation can find a small pneumothorax?

Answer 5

Ct thorax

Question 6

What is the management of a pneumothorax where there is no sob and there is <2cm rim of air?

Answer 6

No treatment
Follow up in 2-4 weeks

Question 7

What is the treatment of a pneumothorax if there is sob and/or >2cm rim of air?

Answer 7

Require aspiration
If aspiration fails 2 times will require chest drain

Question 8

When would a patient recieve surgical management in pneumothorax? (3)

Answer 8

• A chest drain fails to correct the pneumothorax
• There is a persistent air leak in the drain
• The pneumothorax reoccurs (recurrent pneumothorax)

Question 9

What are the surgical options in pneumothorax? (3)

Answer 9

• Abrasive pleurodesis (using direct physical irritation of the pleura)
• Chemical pleurodesis (using chemicals, such as talc powder, to irritate the pleura)
• Pleurectomy (removal of the pleura)

Question 10

What is pleurodesis?

Answer 10

Pleurodesis involves creating an inflammatory reaction in the pleural lining so the pleura sticks together and the pleural space becomes sealed. This prevents further pneumothoraces from developing.

Question 11

What is tension pneumothorax caused by?

Answer 11

Trauma

Question 12

What is the mechanism of a tension pneumothorax?

Answer 12

Trauma creates a one way valve which lets air in on inspiration but not back out again
Keeps getting bigger as breathing

Question 13

What are the signs of tension pneumothorax? (5)

Answer 13

• Tracheal deviation away from side of pneumothorax
• Reduced air entry to affected side
• Increased resonant to percussion on affected side
• Tachycardia
• Hypotension

Question 14

What is the management of tension pneumothorax?

Answer 14

Insert a large bore cannula into the second intercostal space in the midclavicular line.”

Question 15

Where is the chest drain triangle of safety? (3)

Answer 15

• The 5th intercostal space (or the inferior nipple line)
• The mid axillary line (or the lateral edge of the latissimus dorsi)
• The anterior axillary line (or the lateral edge of the pectoris major)

Question 16

What are the 2 key complications of chest drains?

Answer 16

Air leaks around the drain site will lead to persistent bubbling especially on coughing
Surgical empyema

Question 17

What is swinging and bubbling in a chest drain?

Answer 17

Swinging = drain rising and falling with inspiration and expiration

Bubbling = air bubble through showing its working

Question 18

What needs to be done after inserting a chest drain?

Answer 18

Obtain cxr to check positioning