Pneumothorax

Question 1

What is a pneumothorax?

Answer 1

Presence of air in the pleural space.

Question 2

What is the aetiology of pneumothorax?

Answer 2

• Traumatic
• Iatrogenic: CVC, thoracocentesis, mechanical ventilation with barotrauma
• Spontaneous (tall, young males)

Question 3

What are the signs and symptoms of pneumothorax?

Answer 3

• May be asymptomatic
• Acute onset pleuritic chest pain, dyspnoea
• Tachypnoea, tachycardia
• Tracheal deviation (contralateral in tension pneumothorax)
• Ipsilateral diminished chest expansion
• Decreased tactile/vocal fremitus
• Hyperresonance
• Ipsilateral diminished breath sounds

Question 4

What investigations in pneumothorax?

Answer 4

CXR:

• Small: separation of visceral and parietal pleura seen as fine cresenteric line parallel to chest wall at apex
• Large: increased density and decreased volume of lung on side of pneumothorax

Question 5

Treatment pneumothoraces?

Answer 5

• Small: resolve spontaneously; or small intercostal tube with Heimlich valve
• Large: chest tube with underwater seal +/- suction
• Repeated: pleurodiesis with sclerosing agent or apical bullectomy and abrasion