Pneumothorax

Question 1

What are some risk factors for developing a pneumothorax?

Answer 1

• underlying lung disease (bullae, asthma, TB, CF)
• smoker
• cocaine or marijuana use
• previous spontaneous pneumothorax

Question 2

What are some examination findings in a patient with a pneumothorax?

Answer 2

• decreased or absent breath sounds on affected side
• hyperresonance to percussion
• subcutaneous emphysema
• unilateral chest enlargement
• reduced excursion of hemithorax with respiratory cycle
• can be normal!

Question 3

What are some additional findings in a tension pneumothorax?

Answer 3

• distended neck veins, cyanosis, hypotension

Question 4

What are the subtypes of spontaneous pneumothorax?

Answer 4

• primary

- secondary: underlying lung disease eg asthma, TB, CF

Question 5

What is the definition of a small vs large pneumothorax on xray?

Answer 5

• small: < 2cm visible rim of air between lung margin and chest wall
• large: >2cm visible rim of air between lung margin and chest wall

Question 6

What are some treatments for pneumothoraces?

Answer 6

1. small pneumothorax in asymptomatic patients are observed in ED and discharged in 3-6 hours if repeat CXR confirms no progression of pneumothorax
2. large pneumothorax can be managed with needle or catheter aspiration if patient is stable
3. clinically unstable patients, regardless of size of pneumothorax, require intercostal catheter

Question 7

What should patients be told about the medium to long term consequences of having a pneumothorax?

Answer 7

• no air travel 6 weeks
• scuba diving discouraged permanently
• risk recurrence 54% in next 4 years