Pneumothorax

Question 1

Definition?

Answer 1

Air accumulates in the pleural space bet the parietal and visceral pleura.

Question 2

RFs?

Answer 2

• Smoking
• FH
• Tall and slender
• Male
• Young
• Underlying lung disease
• Marfans or ED
• Invasive lung procedures
• Homocysteineuria
• Trauma
Menstruation

Question 3

Ddx?

Answer 3

• Asthma
• COPD
• PE
• MI
• Pleural effusion
• Bronchopleural fistula
• Fibrosis
• Oesophageal perforation
• Bullae

Question 4

Epidemiology?

Answer 4

• Primary spontaneous pneumothorax
	• Sex:♂>♀(approx. 6:1)
	• Peakincidence:20–30 years
• Secondary spontaneous pneumothorax
	• Sex:♂>♀(approx. 3:1)
Peakincidence:60–65 years

Question 5

Aetiology?

Answer 5

• Primary-no obvious cause
• Traumatic
• Secondary -underlying lung disease
Tension-one way valve

Question 6

CP?

Answer 6

• Chest pain-ipsilateral pleuritic
• Dyspnoea
• Ipsilateral reduced breath sounds
• Ipsilateral hyperinflation of hemithorax with hyper-resonance but decreased fremitus
• emphysema
• Hypoxia
• RFs
• Tension
• ARDS cyanosis, restlessness and diaphoresis
• Wounds
• Tachycardia and hypotension
P-THORAX:Pleuriticpain,Tracheal deviation,Hyperresonance,Onset sudden,Reduced breath sounds(anddyspnea),Absentfremitus,X-raysshow collapse

Question 7

Pathophsyiology?

Answer 7

• Muscle tension and elastic recoil creates a high volume of the pleural space and so negative pressure-this causes the pleural membranes to collapse and so causes a vacuum in pleural cavity.
• Air moved into pleural space-equal to atmospheric pressure, so membranes don’t collapse but in fact the expansion of the cavity compresses the lungs and mediastinal structures if severe.
  
  • Lungs pull in collapse
  • Wall-out
• Less exchange of air-less oxygen and carbon dioxide

• Bullae-air pocket on surface breaks-alveoli tear and air leaks-hole in visceral pleura
• Primary-without underlying condition-tall males
• Secondary-underlying lung disease
• Traumatic -through parietal into pleural space
Tension-one way valve to flow into air space as tissue flap-air builds up-increased pressure-compresses structures and tracheal deviation-causes low CO

Question 8

Investigations first line?

Answer 8

exam findings CP

Question 9

Investigations second line?

Answer 9

• CXR
• Rim bt lung margin and chest wall or surgical emphysema
• Absence of lung markings
FBC and clotting studies-INR

Question 10

Investigations third line?

Answer 10

• US-
  
  • No lung sliding
  • A lines-air below pleura
  • Lung point-Pleural layers rejoin each other
  • Barcode sign-above and below pleural line

• CT
	• Pleural line
	• Atelectasis or hyperexpansion
	• Underlying disease
• ABG-
	• Acute resp acidosis
Resp alkalosis

Question 11

M-flow chart?

Answer 11

see ON

Question 12

M-after?

Answer 12

• No diving
• Air travel
• Smoking
Patients may need surgical intervention to prevent recurrence; options include open thoracotomy or video-assisted thoracoscopic surgery (VATS)

Question 13

Prognosis?

Answer 13

• Primary-risk of recurrences with and without surgery is similar
Secondary-higher risk of recurrences

Question 14

Complications?

Answer 14

• Re-expansion pulmonary oedema

Talc-pleurodesis-related ARDS