Pneumothorax Flashcards
def
air in pleural space (between visceral & parietal pleura)
what is a haemothorax
blood in pleural space
what is a chylothorax
lymph in pleural space
def of tension pneumothorax
emergency when a functional valve lets air enter the pleural space during inspiration but not leave during expiration
aetiology of spontaneous pneumothorax
typically tall thin males with previously normal lungs
likely by rupture of subpleural bleb
aetiology of secondary pneumothorax
pre-existing lung disease (COPD, asthma, TB, pneumonia, lung carcinoma)
aetiology of traumatic pneumothorax
penetrating injury to chest
often iatrogenic causes (subclavian/jugular venous cannulation)
risk factors
collagen disorders
marfans & ehlers danlos
epi
spontaneous pneumothorax is 9/100,000PA
20-40yrs
more common in males
history
asymptomatic if small
sudden onset breathlessness, or chest pain which is worse on inspiration
history of a tension pneumothorax
distress with rapid shallow breathing
examination
absent if small
signs of respiratory distress with reduced expansion, hyper-resonance, decreased breath sounds
examination of a tension pneumothorax
severe respiratory distress tachycardia hypotension cyanosis tracheal deviation AWAY from side of pneumothorax
investigations
1 CXR
-dark area of film where lung markings do not extend to
-fluid level may be seen if blood present
2 ABG
-to determine if there is any hypoxaemia, especially in secondary disease
management of a tension pneumothorax
emergency
maximum O2
insert large bore needle into 2nd ICS mid-clavicular line on side of pneumothorax to relieve pressure
insert chest drain afterwards
management of small pneumothorax
<2cm lung-pleural margin
if no underlying disease, pleural fluid, clinical compromise, then reassure, analgesia if required
management of moderate pneumothorax
> 2cm lung-pleural margin
aspiration using large bore cannula or catheter with three way tap, inserted into 2nd ICS midclavicular line
chest drain with water seal if aspiration fails or there is fluid in the pleural cavity, inserted into 4-6ICS space midaxillary line
management of recurrent pneumothoraces
chemical pleurodesis (visceral & parietal pleura fusion with tetracycline) surgical pleurectomy
management - advice
avoids air travel until CXR confirms resolution of pneumothorax
compiications
recurrent pneumothoraces
bronchopleural fistula
prognosis
after one spontaneous pneumothorax, 20% will have another, with frequency increasing with each repeated pneumothoraces
