Pneumothorax Flashcards
What is a pneumothorax?
Air in the pleural cavity.
What is the result of a breach in the pleural space?
Collapse of the elastic lung.
What causes a traumatic pneumothorax?
stabbing, lung puncture by a fractured rib
What could cause iatrogenic pneumothorax?
CT guided lung biopsy, transbronchial lung biopsy, pleural aspiration
What are the types of spontaneous pneumothorax?
- Primary: young patient with no underlying lung disease (normal thin young men)
- Secondary: Patients with underlying lung disease e.g. asthma or COPD.
What is a tension pneumothorax?
A medical emergency where a one-way valve leads to progressive increased air in the pleural space.
What are the results of a tension pneumothorax anatomically and what does this cause?
Increased intrapleural perssure
Mediastinum is pushed across the way (hypoxia and hypotenion)
Venous returned impaired (CO and BP fall)
What can occur if a pneumothorax goes untreated?
Pulseless electrical activity (type of cardiac arrest)
What is the immediate management of a pneumothorax?
Insert venflon in 2nd intercostal space midclavicular line to relieve pressure.
What are risk factors for a spontaneous pneumothorax?
Male
smoking
Being tall
Underlying lung disease.
What is the recurrence rate of spontaneous pneumothorax?
50%
Describe the pathophysiology of primary pneumothorax?
- Development of pleural blebs at lung apex.
- Theory that there can be diffuse, microscopic emphyema below the surface of the visceral pleual
- Spontaneous rupture results in tear of visceral pleura.
- Air flows from airways to pleural space down its pressure gradient.
- Elastic lung then collapses.
What are causes of secondary pneumothorax?
- Weakness in lung tissue e.g. emphysema.
- Increased airway elasticity e.g. pulmonary fibrosis
- Increased airway pressure e.g. asthma, patients on positive ventilation.
What are the symptoms of pneumothorax?
Pleuritic chest pain
Respiratory distress
SOB (may be minimal in primary)
What are the clinical signs of pneumothorax?
- decreased air entry on effected side
- decreased vocal respnance
- hyper-resonant on percussion
- trachael deviation if tension.
What is the differential diagnosis of pneumothorax?
PE
MSK pain
Pleuracy/pneumonia
What can be seen on CXR for a pneumothorax?
Trachael deviation and medistinal shift (away from collapsed lung)
What is defined as a small and large pneumothorax?
Small: <2cm
large >2cm
What would be the management for a small pneumothorax that didnt have many symptoms?
Leave it and observe using serial CXR.
They can be managed as an outpatient.
What management options are their for pneumothorax?
- Observe and manage as outpatient.
- aspirate air with syringe using small bore catheter.
- Intercostal drain with underwater seal.
If a drain fails to work, how would a pneumothorax be managed?
Used video assisted thoracic surgery. Can staple blebs. Can do talc pleurodesis. Can do pleuroabraision. Can do a surgical pleurodesis.
When would a surgical pleurodesis be considered?
If its the 2nd pneumothorax on the same side or first contralateral event.
How long can you not fly for after a spontaneous pneumothorax?
7 days.
How long should you not scuba dive for after a spontaneous pneumothorax?
Should never scuba dive again.
