Pneumothorax Flashcards
Define pneumothorax
Abnormal collection of air within the pleural space, rupturing into the lungs and occasionally causing lung collapse
What group is pneumothorax common in?
Young tall males
(M>F 6:1)
What are the causes of pneumothorax?
Primary:
- Traumatic
- Spontaneous: Weight of lung causes strain on apices
Secondary: Pre-existing lung condition
- COPD
- Asthma
- Carcinoma
- Cystic fibrosis
- TB
- Connective tissue disorders
Describe the presentation of pneumothorax
Asymptomatic if small
Acute and extreme dyspnoea
Sudden pleuritic chest pain
Deviation of Trachea
- Tension is deviated away from affected side
- Non-Tension is deviated towards
Absent breath sounds
Tachypnoeic
Hyper-resonant on percussion
Reduced chest expansion
Hypotension
- Tension
What is the management of primary pneumothorax?
Rim of air <2 cm and patient not breathless
- Discharge with early follow-up
Rim of air >2 cm and breathless
- Pleural aspiration
- If aspiration fails move to intercostal drain
What CXR signs are seen in pneumothorax?
Black area due to air within pleural cavity
Well defined crisp edge of collapsed lung (smaller white area)
Absence of lung markings beyond lung edge
Tension
- Mediastinal shift
- Diaphragm pushed down on affected side
Signs of trauma, such as rib fractures
What does it mean if a chest drain is swinging?
It is in the pleural space and not blocked
water seal should rise on inspiration and fall on expiration
What does it mean if a chest drain is bubbling?
It is not draining any air
When can a chest drian be removed?
Bubbling has ceased
Lung has fully expanded, which can be assessed by CXR
What are the suitable sites for needle decompression/pleural aspiration?
2nd intercostal space mid-clavicular line
What can prevent recurrent pneumothoraces?
Smoking cessation
What is the management of secondary pneumothorax?
Rim of air <1cm
- Admit, observe and give oxygen
Rim of air >1cm
- Intercostal drain
What is the management of a pneumothorax if the lungs fail to expand after initial treatment?
Refer to respiratory specialist
Consider suction ± pleurodesis (artificial obliteration of the pleural space)
What are the safe triangle boundaries for chest drain insertion?
The 5th intercostal space, or the inferior nipple line
The mid axillary line, or the lateral edge of the latissimus dorsi
The anterior axillary line, or the lateral edge of the pectoris major
What is a tension pneumothorax?
Occurring following thoracic trauma in which a one way valve/flap is formed in the lung tissue, meaning air can get in but can’t escape causing pressure to rise
