Pneumothorax Flashcards
What is pneumothorax (PTX)?
AIR in the pleural space, resulting in partial/complete lung collapse.
What are the types of pneumothorax?
- Spontaneous pneumothorax
- Traumatic pneumothorax
- Iatrogenic pneumothorax
- 🚩Tension pneumothorax 🚩
What characterizes primary spontaneous pneumothorax?
Occurs without underlying lung disease, often in tall/thin/young individuals, associated with rupture of subpleural blebs or bullae.
What is secondary spontaneous pneumothorax?
Occurs with** pre-existing lung disease **such as COPD, asthma, cystic fibrosis, lung cancer, and connective tissue disorders like Marfan’s.
What is catamenial pneumothorax?
Occurs in menstruating women, caused by endometriosis in the thorax.
What causes traumatic pneumothorax?
Penetrating or blunt chest trauma, leading to lung injury and pleural air accumulation.
What defines tension pneumothorax?
Severe pneumothorax causing displacement of mediastinal structures with specific signs like respiratory distress and hypotension.
What are the specific signs and symptoms of tension pneumothorax?
- Respiratory distress
- Hypotension
- Tracheal deviation away from the side of the pneumothorax
What are common symptoms of pneumothorax?
- Sudden onset dyspnoea
- Chest pain (often pleuritic, worse on breathing/coughing)
What signs indicate the presence of pneumothorax?
- Hyper-resonant lung percussion
- Reduced breath sounds + lung expansion
- Tachypnoea
- Tachycardia
What is the initial investigation for pneumothorax?
CXR showing loss of lung markings in the periphery.
What is the management approach for no/minimal symptoms of pneumothorax?
Conservative care, regardless of pneumothorax size, with discharge and follow-up in 2-4 days.
What are high risk characteristics in symptomatic pneumothorax?
- Haemodynamic compromise
- Hypoxia
- Bilateral pneumothorax
- Underlying lung disease
- Haemothorax
- Age > 50 with significant smoking
What is the treatment for high-risk symptomatic pneumothorax?
Chest drain.
What is the size threshold for intervention in pneumothorax?
Generally any pneumothorax ≥ 2cm is safe to intervene on with radiology support.
What is the follow-up care for primary spontaneous pneumothorax?
Outpatient review every 2-4 days.
What is the follow-up care for secondary spontaneous pneumothorax?
Inpatient care followed by outpatient follow-up in 2-4 weeks.
What is the purpose of needle aspiration in pneumothorax management?
To resolve pneumothorax, followed by discharge and outpatient follow-up in 2-4 weeks.
What are discharge advice recommendations after pneumothorax management?
- Stop smoking
- Flying: CAA - 2 weeks, BTS - 6 weeks after successful drainage with NO residual air
- Scuba diving: Avoid unless patient has undergone bilateral surgical pleurectomy + has normal lung function/chest CT.
What is the treatment for persistent/recurrent pneumothorax?
Video-assisted thoracoscopic surgery (VATS).
What are the causes of tension pneumothorax?
- Traumatic (penetrating or blunt chest trauma)
- Iatrogenic (thoracentesis, central venous catheter placement, positive pressure mechanical ventilation)
- Spontaneous (underlying lung diseases, lung blebs)
What are the symptoms of tension pneumothorax?
- Acute onset pleuritic chest pain
- Tachypnoea
- Dyspnoea
What signs indicate tension pneumothorax?
- Hyperresonance on percussion
- Diminished breath sounds
- Tracheal deviation away from affected side
- Signs of shock (hypotension, tachycardia)
What is the management goal for tension pneumothorax?
To decompress the pleural space.
What are the management steps for tension pneumothorax?
- Needed thoracostomy
- Chest drain
