Pneumothorax

Question 1

What is a pneumothorax?

Answer 1

Air within the pleural space.

Question 2

What are the signs and symptoms of pneumothorax?

Answer 2

Ipsilateral chest pain.
Shoulder tip pain.
Dyspnoea.
Tachypnoea.
Hypoxia.
Cyanosis.
Auscultation: decreased on affected side.
Percussion: hyper resonant or normal.

Question 3

What are the causes of pneumothorax?

Answer 3

Rupture pleural bleb.
COPD.
TB.
Sarcoidosis.
Idiopathic pulmonary fibrosis.
Rheumatoid arthritis.
Ankylosing spondylitis.
Lung cancer.
Trauma, e.g. stab wound.

Question 4

What is the pathophysiology of pneumothorax?

Answer 4

Directly linked to the cause.
Primary spontaneous pneumothorax: idiopathic/ rupture of pleural bleb, usually found in young, tall, slim men.
Secondary spontaneous pneumothorax: in patients with prior lung disease, e.g. COPD, sarcoidosis or idiopathic pulmonary fibrosis.
Tension pneumothorax: due to blunt, traumatic injuries, e.g. a stab wound. Air cannot be removed on expiration due to one-way valve mechanism, leading to mediastinal shift and lung collapse.

Question 5

What are the complications of pneumothorax?

Answer 5

Risk of future pneumothorax.
Respiratory failure.
Cardiac arrest.

Question 6

What is the treatment of pneumothorax?

Answer 6

If pneumothorax on CXR <2cm then no treatment is required; advise patients not to travel by air or to dive.
If >2cm then aspirate air ± intercostal drain.
Tension pneumothorax requires immediate decompression with a large bore needle inserted into the 2nd intercostal space mid-clavicular line.

Question 7

What investigations are conducted for suspected pneumothorax?

Answer 7

CXR: pleural line; may show tracheal deviation away from lesion.
CT scan.
ABG: hypoxia.