Pneumothorax

Question 1

What is a pneumothorax and how are they classified?

Answer 1

A pneumothorax is an abnormal collection of air in the pleural space. This can result in lung collapse.

1. Primary spontaneous pneumothorax
2. Secondary pneumothorax (associated with underlying disease
3. Traumatic pneumothorax
4. Iatrogenic pneumothorax

Question 2

What is a tension pneumothorax?

Answer 2

A tension pneumothorax develops from a pneumothorax. As the lungs continues to leak air into the chest, it compresses the mediastinum and causes a shift of other structures int eh chest. This is known as a tension pneumothorax and is life threatening.

Question 3

How does a pneumothorax present?

Answer 3

chest pain - sudden onset, sharp/tight
dyspnoea
cough
tachycardia
tachypnoea
fatigue

Previous pneumothorax- suggests secondary to underlying disease or history of spontaneous pneumothorax
History of recent trauma = Traumatic pneumothorax

Question 4

What are the risk factors for a pneumothorax?

Answer 4

Smoking
Male
Previous pneumothorax

Question 5

How is a pneumothorax detected on examination?

Answer 5

Tachypnoea
Raised JVP
Obvious pain
Tachycardia (>135 = tension)
Deviated trachea (away from site = Tension)
Decreased chest expansion unilaterally
Hyper-resonant percussion on affected side
Reduced/inaudible breath sounds on affected side
Reduced vocal fremitus
No added sounds

Question 6

How is a pneumothorax diagnosed?

Answer 6

1. History
2. Examinations
3. CXR
   
   • Deviated trachea
   • Mediastinal shift
   • Depressed hemi-diaphragm
   • compressed/collapsed lung
   • Visible +displaced lung edge
4. USS
5. ABG’s (hypoxia)

Question 7

What causes a pneumothorax?

Answer 7

Spontaneous
= Rupture of cyst/small sac on lung edge
= Genetic susceptibility

Secondary
 = Asthma
 = COPD
 = Cystic fibrosis
 = Lung cancer

Traumatic pnuemothorax
= Trauma e.g. fractured rib, stab wound

Iatrogenic pneumothorax
= Surgical incision

Question 8

How is a pneumothorax treated?

Answer 8

Small pneumothorax + no underlying disease = Self-limiting (1-2 weeks)

Large pneumothorax/pneumothorax with underlying disease = Aspiration with/without chest drain to evacuate the air

Question 9

Where is a chest drain inserted?

Answer 9

A chest drain is inserted in the ‘safe triangle’:
lower border of axilla in the 5th intercostal space,
lateral border or pectoralis major
lateral border of latissmus dorsi

Overall: 5th Intercostal space in the mid-axillary line

Question 10

Where is thoracocentesis performed for a pneumothorax?

Answer 10

In the mid-clavicular line, 2nd intercostal pace, above the rib (to avoid the neurovascular bundle).