Pneumothorax

Question 1

What is a pneumothorax?

Answer 1

Accumulation of air in the pleural space

Question 2

Name some risk factors for pneumothorax.

Answer 2

• Tall
• Thin
• Male
• Young <40
• Smoker
• Lung disease
• FHx

Question 3

Outline the classification of pneumothoraces.

Answer 3

SPONTANEOUS PNEUMOTHORAX

Primary spontaneous
-No precipitating disease/event, due to rupture of a bleb

Secondary spontaneous
- Underlying lung disease

TRAUMATIC PNEUMOTHORAX
- Penetrating injury to chest, may be iatrogenic

TENSION PNEUMOTHORAX

• Air enters pleural space through a function valve during inspiration but does not leave during expiration
• Intrapleural pressure > atmospheric pressure

Question 4

Outline the pathophysiology of pneumothorax.

Answer 4

• Air moves into pleural space
• Lung becomes smaller
• Chest wall expands
• Lobe may collapse
• Alveolar compression

Question 5

Name some signs of a spontaneous pneumothorax.

Answer 5

• Sudden onset dyspnoea/chest pain, worse on inspiration

- Stabbing pan may radiate to shoulder

Question 6

Name 4 signs of a pneumothorax.

Answer 6

• Tachypnoea
• Reduced lung expansion
• Ipsilateral hemithorax hyperresonance
• Ipsilateral hemithorax hyperexpansion

Question 7

Investigations for a pneumothorax

Answer 7

CXR:

• dark area of lung, where lung markings do not extend to
• visible visceral pleura
• ipsilateral expansion of hemithorax
• may see atelectasis

Question 8

How would you manage a small pneumothorax?

Answer 8

• Oxygen
• Analgesia
• Avoid air travel for 6 weeks

Question 9

How would you manage a moderate pneumothorax?

Answer 9

• Percutaneous aspiration - removes air from pleural space

- 3 follow up CXR: immediate, 2h after and 1 week later

Question 10

How would you manage a recurrent pneumothorax?

Answer 10

Pleurodesis

- this obliterates the pleural space by pleural adhesion

Question 11

Name 2 complications of a pneumothorax

Answer 11

• Recurrent pneumothorax (20%)

- Bronchopleural fistulae

Question 12

Outline the pathophysiology of a tension pneumothorax.

Answer 12

• Air enters pleural space on inspo but does not leave on expo, leasing to increased intrpleural pressure
• This can push the mediastinum towards the contralateral lung
• If the heart is squeezed, this can lead to decreased venous return

Question 13

What are the symptoms of a tension pneumothorax?

Answer 13

• Sudden onset chest pain and dyspnoea, worse on inspiration

- Tachypnoea

Question 14

What are the signs of a tension pneumothorax?

Answer 14

• Tachycardia
• Hypotension
• Cyanosis
• Tracheal deviation to contralateral side
• Raised JVP

Question 15

How would you manage a tension pneumothorax?

Answer 15

• Oxygen
• Immediate decompression: Relive intrapleural pressure by inserting large-bore catheter into 2nd ICS, MCL, then insert chest drain