Pneumothorax And Pleural Effusion

Question 1

What is pneumothorax?

Answer 1

Air within the pleural cavity. Disrupts the negative pressure of the pleural space and causes lung collapse

Question 2

What causes tension pneumothorax?

Answer 2

Valve like properties of the interrupted pleural seal cause one way flow of air into the pleural cavity, resulting in compression of the lung and mediastinal shift, alongside tachycardia and hypoxia.

Question 3

What is primary pneumothorax?

What are some risk factors?

Answer 3

Pneumothorax in those with no underlying lung pathology.

Male gender, family history of pneumothorax, smoking, young.

Question 4

What are risk factors for secondary pneumothorax?

Answer 4

COPD,
Asthma,
Bronchiectasis,
Lung cancer,
Marfans syndrome/Ehlers danlos syndrome,
Infections of lung eg TB

Question 5

What is the main cause of a spontaneous pneumothorax?

Answer 5

Bursting of a subpleural blen/bullus.

Question 6

What is an iatrogenic cause of pneumothorax?

Answer 6

Insertion of a central line or pacemaker, lung surgeries etc.

Question 7

What is the most common type of pneumothorax?

Answer 7

Simple spontaneous primary pneumothorax.

Question 8

How might simple pneumothorax present?

Answer 8

Sharp pleuritic chest pain with shortness of breath and history of trauma or lung disease.

Question 9

Upon examination, what is found in simple pneumothorax?

Answer 9

Chest movement reduced on affected side,
Hyper resonance on percussion.
Reduced lung sounds,
Reduced vocal resonance.

Question 10

What are the radiological findings in simple pneumothorax?

Answer 10

Lung hyperlucency,
Absent lung markings,
Collapsed lung borders.

Question 11

What options are there for treatment of simple pneumothorax?

Answer 11

Pleural aspiration (max 2.5L drained),
Chest drain under ultrasound guidance,
Conservative management.

Question 12

What are the borders of the safe triangle for chest drains?

Answer 12

Superior - base of axilla,
Inferior - 5th intercostal space,
Anterior - lateral edge of pectoralis major,
Posterior - lateral edge of latissimus dorsi muscle

Question 13

What additional signs and symptoms are seen in tension pneumothorax?

Answer 13

Respiratory distress,
Cyanosis,
Tachycardia,
Hypoxaemia,
Deviated trachea.

Question 14

How is tension pneumothorax treated?

Answer 14

Emergency needle decompression in the 2nd intercostal space mid clavicular line.

Question 15

What is pleural effusion?

Answer 15

Excess fluid within the pleural cavity

Question 16

What are the four types of pleural effusion?

Answer 16

Simple effusion - pleural fluid (transudate or exudate).
Haemothorax - blood.
Chylothorax - lymph.
Empyema - pus.

Question 17

What signs and symptoms are seen in pleural effusion?

Answer 17

Reduced chest movement on affected side,
Dull, stony percussion,
Vesicular reduced breath sounds,
Reduced vocal resonance,
Shortness of breath,
Pleuritic chest pain.

Question 18

What findings are seen on imaging for pleural effusion?

Answer 18

Meniscal lines, white lower lobe opacifications.

Question 19

What is the most common cause of haemothorax and chylothorax?
What about empyema?

Answer 19

Trauma.

Infection.

Question 20

What further investigations can be done for pleural effusion?

Answer 20

Pleural aspiration (ultrasound guided).
Test protein levels, glucose levels, LDH, pH and cultured for organisms.

Question 21

What is the difference between transudate and exudate?

Answer 21

Transudate - <0.5 pleural serum protein, <0.6 pleural:serum LDH ratio.

Exudate - >0.5 pleural serum protein, >0.6 pleural:serum ratio.

Question 22

Which conditions commonly cause transudate?

Answer 22

Congestive cardiac failure, nephrotic syndrome, liver cirrhosis, hypoproteinaemia.

Question 23

Which conditions commonly cause exudate?

Answer 23

Infection (TB, pneumonia), lung malignancy, pulmonary infarction.

Question 24

What treatments are available for pleural effusion?

Answer 24

Chest aspiration,

Indwelling pleural catheters and pleurodesis (obliteration of the pleural space) in those with recurrent effusion.

Question 25

What X-ray features indicate a tension pneumothorax over a simple pneumothorax?

Answer 25

Marked lung expansion and hyperinflation,
Mediastinal shift away from affected side,
Tracheal deviation away from affected side.