Pneumothorax Flashcards
Define pneumothorax
…air gains access to and accumulates in the pleural space
Epidemiology
More common in men
RFs are smoking, marfans, homocystinuria, relevant FMx, underlying pulmonary disease
Classes of pneumothorax
Primary spontaneous: w/o trauma or event and develops w/o clinical apparent pulmonary disease
Secondary spontaneous: occurs as a complication of an underlying pulmonary disease
Iatrogenic: caused by invasive procedures
Traumatic
Tension: any of the above which goes onto impair lung function
Pathophysiology of pneumothorax
Normally:
alveolar pressure > intrapleural pressure < atmospheric pressure
A communication between alveolus and pleural space or pleural space and atmosphere gases will follow the gradient into the pleural space
Pathophysiology of tension pneumo
Medical emergency
Occurs when intrapleural pressure exceeds atmospheric pressure. This eventually results in hyperaemia and resp. failure
Presenting symptoms
Dyspnoea
Ipsilateral CP
Hyper expanded ipsilateral hemithorax
COPD/Asthma may become acutely worse
Signs
Reduced expansion
Hyper resonance to percussion
Diminished breath sounds
Trachea deviated contra laterally in tension pneumo
Differentials and how to differentiate them
PE: significantly different PMHx
Acute exacerbation of asthma: expiratory wheeze/chest tightness
Acute exacerbation of COPD: Fever, increased cough and change in sputum colour
Pleural effusion: Pain at first but subsides as the condition progresses
Myocardial ischemia
Gold standard investigation and classic feature on it
CXR: look for visceral pleural line
Other imaging
CT
Bronchoscopy
Chest US
Criteria for diagnosis of pneumothorax
Visible rim <=2cm between lung margin and chest wall at level of hilum on PA film
Management of tension pneumothorax
Immediate decompression
Insert catheter at intersection of mid clavicular line at 2nd or 3rd ICS
Management of primary spont. pneumo
Small: obs + supplemental oxygen
Large: Percutaneous aspiration + O2
Management of SSPneumo if pt is clinically unstable or has no contraindications to chest tube
Hospitalisation + obs + O2 + thoracotomy if pneumo is large
Management of SSPneumo if pt is clinically stable or has contraindications to chest tube
Supplemental O2 + obs
