Pneumothorax Flashcards
Definition
Air in the pleural space (the potential space between visceral and parietal pleura). May also be haemothorax or chylothoras (lymph)
Tension pneumothorax is when a functional valve lets air in but not out. More
severe than a normal pnemuothorax
Aetiology
Spontaneous: in patients with no previous history, often due to rupture of
pulmonary bleb.
Traumatic: often iatrogenic (ie. Insertion of CVL).
Secondary: patient with pre existing lung disease (COPD, Fibrotic chronic
disease, TB, pneumonia, CF, malignancy)
Risk factors
collagen disorders like Marfans and Ehlers Danlos
Tall skinny boys
Epidemiology
Annual incidence of spontaneous 9/100k.
Mainly young tall males, 20-40
Presenting symptoms
May be asymptomatic when small
Sudden onset chest pain and breathlessness
Chest pain worse when breathing in
Tension: shallow breathing, labored, distress
Signs on physical examination
Increased resonance but decreased breath sounds on the side of pneumothorax
Asymmetrical chest, reduced expansion.
Tension: hypotense, tachycardic, shallow rapid breathing, distressed, cyanosis, dilated neck veins, tracheal deviation
Investigations
CXR: diagnostic. Decreased lung markings on the side of the PTX, with a clear line. Some small ones can only be seen on expiration. There may be tracheal deviation.
Blood: ABG, to determine if hypoxaemic
Management plan
Tension PTX: Max O2, insertion of a large bore needle into 2ICS MCV. Insert chest drain in 4ICS MAXL later.
Small PTX: monitor and give analgesia
Medium PTX: may need draining with 3way tap, 2.5L/time, from 2ICS MCV. May need chest drain with water seal on 4ICSMAXL but monitor and assess
Recurrent pneumothoraces: chemical pleurodesis (fusion of visceral and parietal pleura)
Advice: avoiding travel and diving until next follow up.
Possible complications
Recurrence, bronchopleural fistula
Prognosis
After the first, recurrence rate 20%. Frequency of recurrence increases with
number of PTX.
