Pneumothorax

Question 1

What is a pneumothorax?

Answer 1

The presence of air within the pleural cavity

Question 2

What can cause a pneumothorax?

Answer 2

Trauma - stabbing, rib fracture
Iatrogenic- CT guided or trans bronchial lung biopsy, pleural aspiration
Spontaneous
Secondary sponeteous due to underlying respiratory disease

Question 3

Describe a tension pneumothorax?

Answer 3

A medical emergency where the one way valve leads to an increased intrapleural pressure which impairs venous return, cardiac output and causes hypotension

Question 4

How is a tension pneumothorax managed in the immediate setting?

Answer 4

Venflon into 2nd intercostal space, midclavicular line to relieve pressure

Question 5

List the epidemiological risk factors for a spontaneous pneumothorax?

Answer 5

Men
Smoker
Tall height

Question 6

It is likely that a pneumothorax will recur. T/F?

Answer 6

True - there is a 40-50% of recurrence after the first episode

Question 7

Describe the development of a primary pneumothorax

Answer 7

Spontaneous rupture of the visceral pleura allows air to flow from the airway to the pleural space down a pressure gradient which results in collapse of the elastic lung.
There is a formation of sub pleural blebs or bull at the lung apex and possible diffuse emphysema below the visceral pleura

Question 8

What underlying abnormalities can lead to secondary pneumothorax?

Answer 8

Inherent weakness in the lung tissue such as in emphysema
Increased airway pressure such as in asthma or ventilated patients
Increased lung elasticity such as pulmonary fibrosis

Question 9

Secondary pneumothorax has a better prognosis than primary pneumothorax. T/F?

Answer 9

False. - secondary has a worse prognosis

Question 10

What are the signs and symptoms of a pneumothorax?

Answer 10

Pleuritic chest pain
Breathlessness
Respiratory distress
Reduced air entry on affected side
Hyperresonance to percussion
Reduced vocal resonance
Tracheal deviation if tension pneumothorax

Question 11

What are the differential diagnoses of pneumothorax?

Answer 11

Pulmonary thromboembolism
Musculoskeletal pain
Pleurisy/penumonia

Question 12

Size is more important than symptoms when decide how to manage a pneumothorax. T/F?

Answer 12

False - the opposite is true

Question 13

What size of a pneumothorax is considered to be large?

Answer 13

> 2cm

Question 14

If a pneumothorax is small and not very symptomatic, how might it be managed?

Answer 14

Serial CXR for observation

Question 15

Where would a catheter be inserted to aspirate a pneumothorax?

Answer 15

2nd intercostal space, midclavicular line

Question 16

When would a chest drain be used to manage a spontaneous pneumothorax?

Answer 16

If pneumothorax >2cm or causes breathlessness

If 16-18G cannula aspiration fails

Question 17

When would a patient with a pneumothorax be referred to surgery?

Answer 17

If chest drain fails to work in 5 days

Question 18

What are the possible surgical management strategies for a pneumothorax?

Answer 18

Stapling blebs
Talc pleurodesis
Pleural abrasion/stripping

Question 19

When, in the management of a pneumothorax, would a surgical pleurodesis be considered?

Answer 19

If a second pneumothorax develops

Professional considerations e.g. airline pilots, scuba divers

Question 20

How long after recovery from a spontaneous pneumothorax should a patient wait before flying?

Answer 20

7 days or more

Question 21

How long after recovery from a spontaneous pneumothorax should a patient wait before diving?

Answer 21

The patient should not dive again