Pneumothorax

Question 1

How common is it?

Answer 1

Spontaneous pneumothorax occurs in 7.4 to 18 per 100,000 men each year and 1.2 to 6 per 100,000 women each year.

Question 2

Who does it effect?

Answer 2

Spontaneous - commonest in young males, male:female = 6:1, often tall and thin, can happen in >40s

Traumatic ?probably more common in males

Question 3

What causes pneumothorax?

Answer 3

Spontaneous:

• in the young is usually caused by the rupture of a pleural bleb (due to congenital defects in connective tissue of alveolar walls)
• in >40s usual cause is underlying COPD
• Rarer causes include bronchial asthma, carcinoma, lung abscess breakdown, pulmonary fibrosis

Trauma:
- Severe blunt or penetrating chest wound

Question 4

What risk factors are there (and how can they be reduced)?

Answer 4

Being male
Being 20-40
Being tall and thin
Chronic lung disease (esp. COPD)
Smoking
Previous pneumothorax
Mechanical ventilation

Question 5

How does pneumothorax present?

Answer 5

Very small - few signs

Small-medium - sudden onset pleuritic pain, progressively increasing breathlessness

Large/tension - tracheal shift, pallor, breathlessness, tachycardia, syncope

Question 6

What signs may the patient have on examination?

Answer 6

Tracheal shift
Tachycardia
Hyperesonant on affected side
Absent breath sounds on affected side
Respiratory distress
Hypoxia
Hypotension

Question 7

What are the differential diagnoses for pneumothorax?

Answer 7

Cardiac tamponade
Acute exacerbation of asthma/COPD
Pulmonary embolism
MI

Question 8

How would you investigate this patient?

Answer 8

Non-tension pneumothorax:
- Chest x ray

Tension: should be evident on examination!

Question 9

What would you tell the patient and how would you explain the condition to them?

Answer 9

Draw a picture of lungs + pleura

Explain air is trapped between the two forcing the lung to collapse.

Question 10

How do you think the patient and/or family might be affected by the diagnosis? Will it affect their
ability to work/care for themselves?

Answer 10

Isolated occurance - should be able to make full recovery, frightening (if tension) but should not experience sequelae unless…

Recurrance - may cause significant issues with independence if frequent.

Question 11

What questions is the patient likely to have?

Answer 11

Will it happen again?
How long will recovery take?
Will there be any after effects?
Why did it happen?

Question 12

How would you treat a tension/large pneumothorax?

Answer 12

Urgent needle thoracotomy followed by chest drain.

Question 13

How would you treat symptomatic small/medium pnuemothorax?

Answer 13

Needle aspiration and chest drain

Question 14

How would you treat recurrent pneumothorax?

Answer 14

Bleb resection (pleurectomy)
Chemical pleurodesis - if surgery contraindicated

Question 15

What other health care professionals might be involved in their care?

Answer 15

Nurses
CT surgeon
Respiratory physician