Pneumothorax

Question 1

What is a pneumothorax?

Answer 1

Air in the pleural cavity.

Question 2

What is the result of a breach in the pleural space?

Answer 2

Collapse of the elastic lung.

Question 3

What causes a traumatic pneumothorax?

Answer 3

stabbing, lung puncture by a fractured rib

Question 4

What could cause iatrogenic pneumothorax?

Answer 4

CT guided lung biopsy, transbronchial lung biopsy, pleural aspiration

Question 5

What are the types of spontaneous pneumothorax?

Answer 5

• Primary: young patient with no underlying lung disease (normal thin young men)
• Secondary: Patients with underlying lung disease e.g. asthma or COPD.

Question 6

What is a tension pneumothorax?

Answer 6

A medical emergency where a one-way valve leads to progressive increased air in the pleural space.

Question 7

What are the results of a tension pneumothorax anatomically and what does this cause?

Answer 7

Increased intrapleural perssure
Mediastinum is pushed across the way (hypoxia and hypotenion)
Venous returned impaired (CO and BP fall)

Question 8

What can occur if a pneumothorax goes untreated?

Answer 8

Pulseless electrical activity (type of cardiac arrest)

Question 9

What is the immediate management of a pneumothorax?

Answer 9

Insert venflon in 2nd intercostal space midclavicular line to relieve pressure.

Question 10

What are risk factors for a spontaneous pneumothorax?

Answer 10

Male
smoking
Being tall
Underlying lung disease.

Question 11

What is the recurrence rate of spontaneous pneumothorax?

Answer 11

50%

Question 12

Describe the pathophysiology of primary pneumothorax?

Answer 12

• 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.

Question 13

What are causes of secondary pneumothorax?

Answer 13

• Weakness in lung tissue e.g. emphysema.
• Increased airway elasticity e.g. pulmonary fibrosis
• Increased airway pressure e.g. asthma, patients on positive ventilation.

Question 14

What are the symptoms of pneumothorax?

Answer 14

Pleuritic chest pain
Respiratory distress
SOB (may be minimal in primary)

Question 15

What are the clinical signs of pneumothorax?

Answer 15

• decreased air entry on effected side
• decreased vocal respnance
• hyper-resonant on percussion
• trachael deviation if tension.

Question 16

What is the differential diagnosis of pneumothorax?

Answer 16

PE
MSK pain
Pleuracy/pneumonia

Question 17

What can be seen on CXR for a pneumothorax?

Answer 17

Trachael deviation and medistinal shift (away from collapsed lung)

Question 18

What is defined as a small and large pneumothorax?

Answer 18

Small: <2cm

large >2cm

Question 19

What would be the management for a small pneumothorax that didnt have many symptoms?

Answer 19

Leave it and observe using serial CXR.

They can be managed as an outpatient.

Question 20

What management options are their for pneumothorax?

Answer 20

1. Observe and manage as outpatient.
2. aspirate air with syringe using small bore catheter.
3. Intercostal drain with underwater seal.

Question 21

If a drain fails to work, how would a pneumothorax be managed?

Answer 21

Used video assisted thoracic surgery. 
Can staple blebs.
Can do talc pleurodesis. 
Can do pleuroabraision. 
Can do a surgical pleurodesis.

Question 22

When would a surgical pleurodesis be considered?

Answer 22

If its the 2nd pneumothorax on the same side or first contralateral event.

Question 23

How long can you not fly for after a spontaneous pneumothorax?

Answer 23

7 days.

Question 24

How long should you not scuba dive for after a spontaneous pneumothorax?

Answer 24

Should never scuba dive again.