Pneumothorax Flashcards
where is air in pneumothorax
plural space
2 causative mechanisms of pneumothorax
Trauma to chest cavity
“Spontaneous” plural bleb rupture
Pathophysiology pneumothorax
Air escaping expands to fill pleural space (or part of it is adhesions between visceral and parietal pleura)
Increase in pressure causes lung to recoil and partially deflate
Tension Pneumothorax
often caused by NIV
valve formed over rupture meaning more air enters plural space on inspiration but cannot escape on expiration, trapped air increases pressure further with each breath causing lung to progressivley deflate.
RF Pneumothorax
Male
Tall thin body habitus
Smoking
Pre-existing Lung disease: COPD / Asthma / Ca / Abscess / TB
Connective tissue disorders: Marfans / Ehrlers-Danlos
Presentation Pneumothorax
Unilateral pleuritic chest pain SOB (progressive) Tachycardic Reduced expansion Hyper-resonance Decreased breath sounds
Investigations pneumothorax
CXR
Can also be seen on US (fast scan) and CT (exact dimensions if considering surgery etc)
Conservative management of pneumothorax
If not breathless and <2cm (20% radiographic volume) of air on CXR
= 2 weekly reviews until air reabsorbed. initally avoid strenuous exercise
management of symptomatic or large pneumothorax
SOB +/ >2cm air on CXR
= Aspirate air. Review in clinic avoid strenuous exercise
IF recurs insert chest drain and follow up in clinic
management of recurrent pneumothorax
3 in a year = surgical review
Thoroscopy +/- bleb resection
or Chemical pleurodesis