Pneumothorax Flashcards
What is pneumothorax?
Presence of air or other gases in the pleural space
Pneumothorax is commonly referred to as a collapsed lung.
What are the general risk factors for pneumothorax?
Smoking cigarettes or cannabis, vaping
These factors increase the likelihood of developing pneumothorax.
How can pneumothorax be classified?
Based on the initial cause
The main classifications include spontaneous pneumothorax and secondary pneumothorax.
What is primary spontaneous pneumothorax (PSP)?
Pneumothorax that occurs at any time in individuals with no predisposing lung diseases or abnormalities
It typically occurs without a clear cause.
What is the typical age of onset for primary spontaneous pneumothorax?
Young adults
It is less likely to occur in middle-aged and older adults.
In which demographic is primary spontaneous pneumothorax most common?
Tall and thin individuals
This demographic is particularly vulnerable to this condition.
What is a bleb?
Small air sac that forms on the visceral pleura (outer layer) of the lung
Blebs are often associated with primary spontaneous pneumothorax.
What is a bulla?
Larger air sac that forms from damaged alveolar walls or merging blebs
Bullae are more common in individuals with lung conditions such as COPD or emphysema.
What is the pathophysiology of pneumothorax?
Formation of apical subpleural blebs that rupture and leak air into the pleural space
This causes the lung to collapse.
Which genetic factors are associated with a higher predisposition to pneumothorax?
Individuals with FLCN mutation
Genetic predisposition can increase the risk of developing pneumothorax.
Name four pneumothorax-associated genetic conditions.
- Marfan’s syndrome
- Vascular Ehlers-Danlos syndrome
- Alpha-1 antitrypsin deficiency
- Cystic fibrosis
These conditions can increase the risk of pneumothorax.
True or False: Blebs are more common in primary spontaneous pneumothorax, while bullae are more associated with lung conditions.
True
This distinction helps in understanding the underlying causes of pneumothorax.
Fill in the blank: The presence of air in the pleural space causes the lung to _______.
collapse
This is a key consequence of pneumothorax.
Which type of pneumothorax is more common in men than women?
Spontaneous pneumothorax
This condition shows a gender disparity in its occurrence.
What is the typical location of blebs?
Subpleural, thin-walled areas toward the apex of the lung
Their location is significant in the context of pneumothorax.
What is the relationship between smoking and pneumothorax?
Smoking is a general risk factor for developing pneumothorax
Both cigarettes and cannabis use increase this risk.
What is Secondary Spontaneous Pneumothorax (SSP)?
Pneumothorax that occurs in individuals with underlying chronic lung disease.
What is the epidemiology of SSP?
More common in older adults around 60 years old, most commonly due to COPD or emphysema, but can occur in other chronic conditions such as CF, ILD, TB, lung cancer, pneumonia, and ILD-CTD diseases.
What is the pathophysiology of SSP?
Formation of subpleural bullae within the peripheral lung parenchyma that rupture and leak air into the pleural space, causing lung collapse.
What are the presentations of SSP?
Dyspnea, sudden pleuritic chest pain on the side of the collapsed lung, rapid deterioration of underlying lung condition.
What are the examination findings on the collapsed lung side in SSP?
Reduced chest expansion, hyperresonance to percussion, reduced breath sounds on auscultation.
What is Traumatic Pneumothorax?
Pneumothorax resulting from penetrating or non-penetrating thoracic injury (blunt trauma).
What is Iatrogenic Pneumothorax?
Pneumothorax caused by invasive medical procedures.
What is the epidemiology of Iatrogenic Pneumothorax?
Can occur in anyone who has had a recent medical intervention with pulmonary complications, such as mechanical ventilation or pleural, transbronchial, or transthoracic biopsies.
What are the presentations of Iatrogenic Pneumothorax?
Onset within a few hours of medical intervention, dyspnea worse on inspiration, pleuritic pain on the side of the collapsed lung, tachycardia.
What is Accidental/Non-Iatrogenic Pneumothorax?
Pneumothorax caused by direct injury to the thorax.
What is the epidemiology of Accidental Pneumothorax?
Can occur in anyone who has had thoracic trauma such as bullet wounds, knife stabbings, or broken ribs.
How can pneumothorax be classified based on mechanisms of air entry?
- Open pneumothorax: Penetrating thoracic injury that permits entry of air from the environment into the chest. 2. Closed pneumothorax: Non-penetrating/blunt thoracic trauma that permits entry of air from the lungs themselves.
How can pneumothorax be classified based on air accumulation?
Simple pneumothorax: Airflow in and out of pleural space which results in no shift of heart or mediastinal structures.
What is a tension pneumothorax?
Airflow into pleural space but no air outflow, resulting in shift and compression of heart and mediastinal structures.
Why is tension pneumothorax considered a medical emergency?
Mediastinal shift can cause heart and lungs to become compressed, leading to Sudden Cardiac Arrest (SCA).
Can all types of pneumothorax become a tension pneumothorax?
Yes, all types of pneumothorax can become a tension pneumothorax.
What are the early symptoms of tension pneumothorax?
Sudden onset of respiratory distress signs and symptoms: Dyspnea, pleuritic pain radiating to ipsilateral back and shoulder, tachypnea, tachycardia, hypoxia.
What are the early signs of tension pneumothorax?
Cyanosis, jugular venous distension, chest retractions, tracheal deviation away from pneumothorax, hypotension.
What is the measurement for a small pneumothorax?
Less than 2 cm
What is the measurement for a large pneumothorax?
More than 2 cm
What does a chest x-ray show for a primary spontaneous pneumothorax (PSP)?
Apical blebs
What does a chest x-ray show for a secondary spontaneous pneumothorax (SSP)?
Bullae
What indicates a tension pneumothorax on a chest x-ray?
Tracheal deviation away from collapsed lung, mediastinal shift away from collapsed lung
The collapsed lung appears very dark with no/less lung markings compared to normal lung.
What does a chest CT show for pneumothorax?
Black area is air, grey area is collapsed lung
What is the emergency management for tension pneumothorax or severe respiratory distress?
Needle thoracostomy/decompression in 2nd intercostal space and midclavicular line
This procedure sucks air out of the pleural space (chest drain).
What is the oxygen requirement in the management of tension pneumothorax?
100% (high-flow) oxygen
This reduces nitrogen partial pressure in pleural capillaries.
What is the management for small primary spontaneous pneumothorax (PSP) in an asymptomatic patient?
Observe the patient; no treatment is needed.
What is the first-line treatment for large primary spontaneous pneumothorax (PSP) in a symptomatic patient?
Needle decompression.
What is the second-line treatment for large primary spontaneous pneumothorax (PSP) in a symptomatic patient?
Chest tube thoracostomy in the safe triangle.
What is the first-line treatment for small or large secondary spontaneous pneumothorax (SSP) in any patient?
Chest tube thoracostomy in the safe triangle.
What is video-assisted thoracic surgery (VATS) used for?
Surgical pleurodesis and blebectomy/bullectomy.
What is chemical pleurodesis?
Instillation of a sclerosing agent through a chest tube which induces fibrosis in the pleural space.
What does chemical pleurodesis prevent?
Recurrent spontaneous pneumothorax and recurrent pleural effusions.
What is the preferred sclerosant for chemical pleurodesis?
Sterile talc; iodine or doxycycline can also be used.
What is the risk of recurrence for spontaneous pneumothorax?
Spontaneous pneumothorax has a risk of recurrence; iatrogenic pneumothorax has no risk of recurrence.
What should be done after interventions for pneumothorax?
HRCT should be done to ensure the pneumothorax is resolved.
What follow-up is needed if no intervention is performed for pneumothorax?
Regular checkups and x-rays.
What lifestyle changes should a patient consider after pneumothorax resolution?
Smoking cessation, cannot fly for a week, and cannot scuba dive again.
