Pneumothorax

Question 1

Causes of primary pneumothorax

Answer 1

Young patients without any underlying disease.
Often tall and thin

Question 2

Causes of secondary pneumothorax

Answer 2

COPD
Asthma
Cystic fibrosis
Lung cancer
PCP
Connective tissue disease such as marfans

Question 3

What is a tension pneumothorax?

Answer 3

Severe pneumothorax resulting in the displacement of mediastinal structures that may result in severe respiratory distress and haemodynamic collapse

Question 4

Clinical features on examination

Answer 4

Hyperresonant
reduced breathsounds
reduced lung expansion
tachypnoea
tachycardia

Question 5

What are high risk characteristics of pneumothorax that mean a drain is required?

Answer 5

Tension
Hypoxia
Bilaterla
Underlying lung disease
>50 with smoking Hx
Haemothorax

Question 6

What features mean a pneumothorax is safe to drain without further imaging

Answer 6

2cm laterally or apically on CXR

Question 7

Is not safe to intervene with pneumothorax imagining on CXR alone what imaging can be done?

Answer 7

CT imaging

Question 8

When can a chest drain be removed?

Answer 8

When pneumothorax resolved (stopped bubbling spontaneously or resolution on CXR)

Question 9

If no red flag features what options are available for management of pneumothorax?

Answer 9

Procedure avoidance
ambulatory device
needle aspiration

Question 10

If a pneumothorax is asymptomatic what is the preferred management?

Answer 10

Conservative care
reviewed as OP in 2-4 days

Secondary pneumothoraxs should be observed as inpatient

Question 11

When should needle aspiration be done?

Answer 11

Symptomatic
no red flag
patient preference for symptoms relief

Question 12

Management of persistent pneumothorax/ pleurobronchogenic fistula

Answer 12

VATS should be considered for mechanical/ chemical pleurodesis +/- bullectomy

Question 13

Discharge advice for pneumothorax

Answer 13

smoking cessation
Fly 2 weeks post drainage if no resdual air