Pneumothorax Flashcards
Define pneumothorax [3]
- Air within the pleural cavity resulting in negative intrapleural pressure
- opposing forces of chest wall (outwards) and lung (inwards)
- Any breach of the pleural space leads to collapse of the elastic lung
State the 3 types of pneumothorax [3]
- traumatic
- iatrogenic
- spontaneous
Name 2 causes of traumatic pneumothorax [2]
- stabbing
- fractured rib
Name 3 causes of iatrogenic pneumothorax [3]
- CT guided lung biopsy
- TBLB (transbronchial lung biopsy)
- pleural aspiration
Define a tension pneumothorax [3]
- a medical emergency
- caused by a breach in the lung surface that acts as an one way valve, that allows air into the pleural cavity upon inspiration but preventing its escape on expiration,
- leads to increased intrapleural pressure
What are the complications of tension pneumothorax? [4]
- venous return impaired,
- cardiac output falls
- blood pressure falls
- pulse-less electrical activity (PEA) cardiac arrest without intervention
What is the immediate management that must be done for a tension pneumothorax? [1]
insert venflon 2nd intercostal space, midclavicular line to relieve pressure
What are the risk factors for spontaneous pneumothorax? [4]
- Smoking
- Male gender
- Height
- Underlying lung disease (secondary)
Describe the pathophysiology of primary pneumothorax [5]
- Development of subpleural blebs/bullae at lung apex
- Possible additional diffuse, microscopic emphysema below the surface of visceral pleura
- Spontaneous rupture leads to tear in visceral pleura
- Air flows from airways to pleural space (pressure gradient)
- Elastic lung then collapses
Describe the pathological causes of secondary pneumothorax [3]
- Inherent weakness in lung tissue
- (e.g. emphysema)
- Increased airway pressure
- (e.g. asthma, ventilated patient)
- Increased lung elasticity
- (e.g. pulmonary fibrosis)
State the signs [4] and symptoms [3] of spontaneous pneumothorax
- Symptoms:
- Pleuritic chest pain
- Breathlessness (can be minimal if primary)
- Respiratory distress (especially if secondary)
- Signs:
- Reduced air entry on affected side
- Hyper-resonance on percussion
- Reduced vocal resonance
- Tracheal deviation if tension (+/- circulatory collapse)
What are the differential diagnosis of pneumothorax that should be considered? [4]
- PTE (pulmonary embolism)
- Musculoskeletal pain
- Pleurisy
- Pneumonia
What are the management options for pneumothorax? [3]
- Observation (serial CXR) if small or not very symptomatic - can be as outpatient
- Aspiration (small bore catheter 2nd intercostal space midclavicular line - aspirate air with syringe/3 way tap)
- Intercostal drain with underwater seal
What should you do if the drain does work? [6]
- VATS (Video Assisted Thoracic Surgery)
- Considered if not resolved in 5 days
- Can staple blebs
- Talc pleurodesis (causes inflammatory reaction and pleural adhesion, highly effective)
- Pleural abrasion/stripping
- Surgical pleurodesis considered if 2nd pneumothorax on same side, first contralateral event
- Professional considerations (e.g. airline pilots, scuba divers)
After a spontaneous pneumothorax has resolved on CXR, how long should the patient wait before flying? [1]
≥ 7 days
