Pneumothorax

Question 1

What can cause pneumothorax?

Answer 1

Can be spontaneous (esp in thin young men), chronic lung disease, infection, trauma, iatrogenic, carcinoma, connective tissue disorders such as mar fans syndrome

Question 2

What are the classifications of pneumothorax?

Answer 2

Spontaneous primary and secondary, trauma

Question 3

What is a primary spontaneous pneumothorax

Answer 3

Rupture of sub pleural bleb (air sac at apices of lung) which allows air from lungs into pleural cavity. There is no evidence of any underlying causative disease

Question 4

What is a secondary spontaneous pneumothorax

Answer 4

Underlying lung disease that causes perforation of pleura

Question 5

Name the two most common symptoms

Answer 5

Sudden unilateral pleuritic pain and/or breathlessness

Question 6

Which genda tend to be more susceptible

Answer 6

Male

Question 7

Secondary spontaneous pneumothorax tends to occur in what group of people?

Answer 7

Males over 55

Question 8

A larger pneumothorax (>15% of hemidiaphragm) may result in what upon auscultation?

Answer 8

Absent breath sounds

Question 9

What is a tension pneumothorax?

Answer 9

Where the airway and pleural space act as a one way valve causing air to enter but cannot leave resulting in pressures far greater than atmospheric in the pleural cavity causing mediastinal displacement

Question 10

What does the tension pneumothorax result in?

Answer 10

Rapidly progressive breathlessness, tachy, hypotension due to vena cava kinking, cyanosis, tracheal displacement

Question 11

When might a tension pneumothorax not result in a mediastinal shift?

Answer 11

When due to malignancy as scarring splints the mediastinum in place

Question 12

What is a closed pneumothorax

Answer 12

When the communication of air between the two areas stops and lung stays deflated

Question 13

What is good about a closed pneumothorax?

Answer 13

The pleural pressure remains mean negative and over a few days re-inflates itself and infection is uncommon

Question 14

What can happen in a open pneumothorax?

Answer 14

Infection can enter the pleural cavity

Question 15

What is the key investigation?

Answer 15

CXR

Question 16

Management if lung edge less than 2 cm from chest wall without SOB

Answer 16

Usually resolves itself and therefore consider discharge

Question 17

If the patient suffers a spontaneous pneumothorax and is young how would you treat?

Answer 17

Needle aspiration which avoids the need for a chest drain. If this fails retry and if this fails give chest drain

Question 18

How would you treat a secondary spontaneous pneumothorax?

Answer 18

Intercostal chest drain in mid axillary line at ICS 4 or 5 or 6

Question 19

When should you remove the chest drain

Answer 19

24 hours after lung re-inflates

Question 20

When should surgery be done

Answer 20

If there is bubbling in water after 5-7 days for pleuradhesion

Question 21

What should people with a closed pneumothorax NOT do for a few weeks

Answer 21

Fly, closed air expands at low pressures of high altitude

Question 22

When else might you do a pleurodesis?

Answer 22

If pneumothorax recurs

Question 23

What is a pneumothorax?

Answer 23

A pneumothorax is the presence of air in the pleural cavity