Pneumothorax

Question 1

What is a pneumothorax

Answer 1

Air in the pleural cavity causing the affected lung to come away from the thoracic wall

Question 2

What are the types of pneumothorax

Answer 2

Spontaneous - young thin tall men due to rupture of subpleural bulla
Chronic lung disease - asthma, COPD, CF, Lung fibrosis and sarcoidosis
Infection - TB, pneumonia and lung abscess
Traumatic including iatrogenic (CVP line insertion, pleural aspiration or biopsy)
Carcinoma
Connective tissue disorder - Marfans Syndrome, Ehlers Danlos

Question 3

What are the clinical features of a penumothorax

Answer 3

Can be asymptomatic in young fit people with small pneumothoraces
Sudden onset dyspneoa
Pleuritic chest pain
Patients with Asthma or COPD may present with sudden deterioration
Mechanically ventilated - sudden hypoxia or increase in ventilation pressures

Signs

• reduced expansion
• hyper resonance
• diminished breath sounds on affected side

Question 4

what is the clinical difference between a pneumothorax and a tensions pneumothorax

Answer 4

The trachea is deviated in a tension pneumothorax to the opposite side

Question 5

Which investigations should be done in a suspected pneumothorax?

Answer 5

Expiratory CXR
look for area of devoid lung markings, pripheral to the edge of the collasped lung
ABG - in patients who are dyspneoic/hypoxic and those with chronic lung disease

Question 6

What is the management of a tension pneumothorax

Answer 6

DO NOT GET A CXR
clinical diagnosis
Insert a 14-16G cannula with a syringe partially filled with saline in the 2nd Intercostal space in the midclavicular line on side of suspected pneumothorax
Remove plunger to allow air to bubble through the saline until chest drain is inserted
Get a CXR
Insert chest drain

Question 7

What is the difference between a primary and secondary pneumothorax

Answer 7

Primary is in someone with no known lung disease

Secondary - patient has lung disease and if they have connective tissue disease

Question 8

What do the BTS guidelines suggest in a patient with a rim of air <2cm and no SOB

Answer 8

Discharge home

Question 9

When is a chest drain considered in a patient with a primary pneumothorax

Answer 9

If aspiration was unsuccessful (rim of >2cm on CXR and SOB)

Question 10

Which pneumothoraces need to have a chest drain

Answer 10

If aspiration unsuccessful in primary pneumothorax
Pneumothorax due to trauma or mechanical ventilation
Secondary pneumothoraces: IF over 50 yrs old and >2cm rim on CXR and SOB

Question 11

What does the BTS suggest in a patient with a secondary pneumothorax less than 1cm

Answer 11

Oxygen and observation for 24 hours