Pneumothorax

Question 1

What is the difference between primary and secondary pneumothorax?

Answer 1

Primary = spontaneous
Secondary = underlying disease

Question 2

What are the risk factors for primary pneumothorax?

Answer 2

• Young
• Thin
• Athletic
• Male

Question 3

What are the common causes for secondary pneumothorax?

Answer 3

Respiratory

• COPD
• Asthma
• Pneumonia
• Lung abscess/fibrosis
• Lung malignancy
• TB

Connective tissue disease

• Sarcoidosis
• Marfan’s syndrome

Iatrogenic/Trauma

Question 4

What are the common symptoms of pneumothorax?

Answer 4

Sudden SOB onset
Pleuritic chest pain
Sudden detrioration

Question 5

What are the common signs of pneumothorax?

Answer 5

• Reduced breath sounds on affected side
• Reduced expansion on affected side
• Hyperpercussion on affected side

TENSION = trachea deviation AWAY from affected side

Question 6

What are the CXR signs of a simple pneumothorax?

Answer 6

• Visceral pleural line identifiable

- No lung markings beyond this line

Question 7

What CXR signs are present in tension pneumothorax but not simple?

Answer 7

• Mediastinum/trachea shift away from affected side

- Flattening of ipsilateral diaphragm

Question 8

What is the management for primary pneumothorax?

Answer 8

IF <2cm & no SOB = discharge

IF NOT = aspiration (2nd intercostal space mid clavicular)

IF aspiration fails = chest drain (5th intercostal space mid axillary)

Question 9

What is the management secondary pneumothorax?

Answer 9

IF > 50 yrs + > 2cm OR SOB = chest drain

IF NOT = aspiration

IF aspiration fails (still >1cm) = chest drain

IF <1cm after aspiration = oxygen and admission 24h