Pneumothorax

Question 1

def

Answer 1

air in pleural space (between visceral & parietal pleura)

Question 2

what is a haemothorax

Answer 2

blood in pleural space

Question 3

what is a chylothorax

Answer 3

lymph in pleural space

Question 4

def of tension pneumothorax

Answer 4

emergency when a functional valve lets air enter the pleural space during inspiration but not leave during expiration

Question 5

aetiology of spontaneous pneumothorax

Answer 5

typically tall thin males with previously normal lungs

likely by rupture of subpleural bleb

Question 6

aetiology of secondary pneumothorax

Answer 6

pre-existing lung disease (COPD, asthma, TB, pneumonia, lung carcinoma)

Question 7

aetiology of traumatic pneumothorax

Answer 7

penetrating injury to chest

often iatrogenic causes (subclavian/jugular venous cannulation)

Question 8

risk factors

Answer 8

collagen disorders

marfans & ehlers danlos

Question 9

epi

Answer 9

spontaneous pneumothorax is 9/100,000PA
20-40yrs
more common in males

Question 10

history

Answer 10

asymptomatic if small

sudden onset breathlessness, or chest pain which is worse on inspiration

Question 11

history of a tension pneumothorax

Answer 11

distress with rapid shallow breathing

Question 12

examination

Answer 12

absent if small

signs of respiratory distress with reduced expansion, hyper-resonance, decreased breath sounds

Question 13

examination of a tension pneumothorax

Answer 13

severe respiratory distress
tachycardia
hypotension
cyanosis
tracheal deviation AWAY from side of pneumothorax

Question 14

investigations

Answer 14

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

Question 15

management of a tension pneumothorax

Answer 15

emergency
maximum O2
insert large bore needle into 2nd ICS mid-clavicular line on side of pneumothorax to relieve pressure
insert chest drain afterwards

Question 16

management of small pneumothorax

Answer 16

<2cm lung-pleural margin

if no underlying disease, pleural fluid, clinical compromise, then reassure, analgesia if required

Question 17

management of moderate pneumothorax

Answer 17

> 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

Question 18

management of recurrent pneumothoraces

Answer 18

chemical pleurodesis (visceral & parietal pleura fusion with tetracycline)
surgical pleurectomy

Question 19

management - advice

Answer 19

avoids air travel until CXR confirms resolution of pneumothorax

Question 20

compiications

Answer 20

recurrent pneumothoraces

bronchopleural fistula

Question 21

prognosis

Answer 21

after one spontaneous pneumothorax, 20% will have another, with frequency increasing with each repeated pneumothoraces