Pneumothorax

Question 1

What is a pneumothorax?

Answer 1

A pneumothorax is the presence of air in the pleural space, causing lung collapse.

Question 2

What are the types of pneumothorax?

Answer 2

Types include primary spontaneous pneumothorax, secondary spontaneous pneumothorax, traumatic pneumothorax, and tension pneumothorax.

Question 3

What are the common symptoms of a pneumothorax?

Answer 3

Symptoms include sudden onset chest pain and breathlessness.

Question 4

What is the aetiology of primary spontaneous pneumothorax?

Answer 4

It occurs without an apparent cause, typically in tall, thin young males or smokers.

Question 5

What is the aetiology of secondary spontaneous pneumothorax?

Answer 5

It is caused by underlying lung diseases such as COPD, asthma, cystic fibrosis, or interstitial lung disease.

Question 6

What is the aetiology of a traumatic pneumothorax?

Answer 6

It is caused by chest trauma, including penetrating injuries or rib fractures.

Question 7

What is the pathophysiology of a pneumothorax?

Answer 7

Air enters the pleural space, disrupting the negative pressure that keeps the lung inflated, leading to partial or complete lung collapse.

Question 8

What are the risk factors for a primary spontaneous pneumothorax?

Answer 8

Risk factors include male sex, being tall and thin, and smoking.

Question 9

What are the risk factors for a secondary spontaneous pneumothorax?

Answer 9

Risk factors include COPD, asthma, cystic fibrosis, interstitial lung disease, and tuberculosis.

Question 10

What are the clinical signs of a pneumothorax on examination?

Answer 10

Clinical signs include reduced chest expansion, hyper-resonance to percussion, diminished breath sounds, and possibly tracheal deviation in tension pneumothorax.

Question 11

How is a pneumothorax diagnosed?

Answer 11

Diagnosis is confirmed with a chest X-ray, which shows air in the pleural space and lung collapse.

Question 12

What are the key findings on a chest X-ray of a pneumothorax?

Answer 12

A visible pleural edge with no lung markings beyond it and lung collapse.

Question 13

What is a tension pneumothorax?

Answer 13

A life-threatening condition where trapped air in the pleural space causes pressure on the mediastinum and contralateral lung.

Question 14

What are the symptoms of a tension pneumothorax?

Answer 14

Symptoms include severe breathlessness, chest pain, and signs of shock.

Question 15

What are the clinical signs of a tension pneumothorax?

Answer 15

Signs include tracheal deviation, distended neck veins, tachycardia, hypotension, and reduced breath sounds on the affected side.

Question 16

What is the immediate management of a tension pneumothorax?

Answer 16

Immediate needle decompression at the second intercostal space in the mid-clavicular line, followed by chest drain insertion.

Question 17

What is conservative management for a small pneumothorax?

Answer 17

Observation with follow-up if the pneumothorax is small and the patient is asymptomatic.

Question 18

What is the medical management of a pneumothorax?

Answer 18

Medical management includes oxygen therapy and aspiration of air using a needle and syringe.

Question 19

When is surgical management of a pneumothorax indicated?

Answer 19

Surgical intervention, such as pleurodesis or surgical repair, is indicated for recurrent pneumothorax or persistent air leak.

Question 20

What are the differential diagnoses for pneumothorax?

Answer 20

Differential diagnoses include pulmonary embolism, myocardial infarction, pneumonia, and pericarditis.

Question 21

What is pleurodesis?

Answer 21

Pleurodesis is a procedure to obliterate the pleural space, preventing recurrent pneumothorax.

Question 22

How can a traumatic pneumothorax be prevented during procedures?

Answer 22

Use of ultrasound guidance during central line insertion or thoracentesis can reduce the risk.

Question 23

What is the prevalence of primary spontaneous pneumothorax?

Answer 23

It is more common in young males, with an incidence of 7.4–18 per 100,000 per year.

Question 24

What is the prevalence of secondary spontaneous pneumothorax?

Answer 24

It is less common, with an incidence of 6.3 per 100,000 per year.

Question 25

What lifestyle advice can be given to prevent recurrence of pneumothorax?

Answer 25

Avoid smoking and high-risk activities like scuba diving or flying in unpressurised aircraft.