Pneumothorax

Question 1

Define pneumothorax

What are the different types?

Answer 1

Air in the pleural space

• Primary – without preceding trauma or precipitating event
• Secondary – complication of underlying pulmonary disease
• Tension – medical emergency, functional valve allows air to enter the pleural space during inspiration but not leave during expiration
• Traumatic

Question 2

What are the causes/risk factors of a pneumothorax?

Answer 2

Primary
• Smoking
• Tall, slim
• Marfan’s syndrome
• Ehlers-Danlos syndrome

Secondary
• Acute severe asthma
• COPD
• TB
• Pneumonia
• Lung carcinoma
• Cystic fibrosis
• Fibrosing lung disease

Traumatic
• Penetrating chest wall injury
• Invasive medical procedures e.g. thoracocentesis, central venous catheter, biopsy

Question 3

What are the presenting symptoms of a pneumothorax?

Answer 3

• Asymptomatic
• Sudden onset SOB
• Pleuritic chest pain

Question 4

What are the signs of a pneumothorax?

Answer 4

• Hyperexpanded hyper-resonant hemithorax
• Diminished/absent breath sounds

Tension pneumothorax
• Tracheal deviation
• Respiratory distress
• Tachycardia
• Hypotension
• Cyanosis
• Distended neck veins

Question 5

What are the investigations for a pneumothorax?

Answer 5

• CXR
o Absence of lung markings
o Tracheal/mediastinal shift in tension pneumothorax
• ABG – hypoxia

Question 6

What is the management for a pneumothorax?

Answer 6

Tension pneumothorax – medical emergency
• Maximum O2
• Large bore cannula into 2nd ICS MCL
• Insert chest drain

Primary
• Small <2cm –high flow O2, analgesia
• Large >2cm – high flow O2, large bore cannula into 2nd ICS MCL

Secondary
• Small <2cm –high flow O2, large bore cannula into 2nd ICS MCL
• Large >2cm – high flow O2, chest drain

Recurrent
• Chemical pleurodesis with tetracycline or talc

Patient advice
• Avoid air travel until follow up CXR
• Avoid diving

Question 7

What are the complications of a pneumothorax?

Answer 7

• Recurrent pneumothoraces
• Bronchopleural fistula
• Re-expansion pulmonary oedema