Pneumothorax and Pleural Effusion Flashcards
What is a pneumothorax?
Collapse lung.
Air ‘leak’ between the lung and the chest wall.
Varying severity.
Tension = medical emergency
What are the symptoms of pneumothorax?
Breathlessness
Chest pain (worse on inspiration) -some may look well
Cough - usually sudden onset
What are the signs of a pneumothorax?
Dyspnoea
Tachycardia and hypotension (if severe)
Reduced unilateral lung expansion
Resonant percussion note
Quiet or absent breath sounds.
Where can air come from in a pneumothorax?
The lung (most common)
- Primary
- Secondary to underlying lung disease or trauma
- Iatrogenic - high pressure ventilation
Through the chest wall (rare)
-Trauma
0Iatrogenic (insertion of CVP line in neck, fine needle aspiration of breast)
Both the lung and through the chest wall (rare)
-Trauma e.g. stabbing
In who is a primary pneumothorax most common?
Most common in young, tall, thin men.
Smoking increases risk by 9x
How does a primary pneumothorax most commonly occur?
Most cases have a small sub-pleural bleb or bulla that bursts, allowing air into the cavity.
What underlying lung diseases could cause a pneumothorax?
COPD Asthma Bronchoectasis inc. CF Lung cancer Pulmonary infections including pneumonia and TB
What kinds of trauma can cause a secondary pneumothorax?
A fractured rib may puncture the visceral pleura
Severe blunt chest trauma may puncture both parietal and visceral pleura
Mild sharp chest trauma may puncture both parietal and visceral pleura.
What is a tension pneumothorax?
It occurs when air can enter the pleural cavity but cannot escape because of a flap that closes on expiration. This acts like a one-way valve.
It is a life-threatening medial emergency as it will increase the pressure in the chest and begin to ‘crush’ other organs.
What are the symptoms of a tension pneumothorax?
Severe distress and breathlessness
Pleuritic chest pain
Fatigue.
What are the signs of a tension pneumothorax?
Tachycardia and hypotension
Raised JVP
Deviated trachea
Displaced apex beat
Increased percussion note
Silent breath sounds
How do you treat a tension pneumothorax?
Insert a plastic cannula into the second intercostal space in the mid-clavicular line.
Why might a pleural effusion occur due to failure of absorption?
Failure of absorption due to:
- hypoproteinaemia (most common)
- –Liver failure (cirrhosis)
- –Nephrotic syndrome
- congestive heart failure (increased pressure in venous end of capillary)
- Lymphatic obstruction (cancer)
Why might a pleural effusion occur because of over production of pleural fluid?
Increased capillary permeability, usually die to inflammation:
- Infection (pneumonia, pleurisy, TB)
- Cancer (primary or secondary)
- Pulmonary infarction due to pulmonary embolism
What are the symptoms of a pleural effusion?
- Breathlessness
- Chest pain
- Cough
- Usually gradual onset and depends on size (could be asymptomatic)
- Also symptoms relating to underlying cause.
What are the signs of a large pleural effusion?
- Dyspnoea
- Tracheal deviation
- Reduced unilateral lung expansion
- Stony dull percussion note
- Quiet breath sounds
- Reduced vocal resonance
- Also signs of underlying cause
What is the difference in cause of bilateral and unilateral pleural effusion?
Bilateral - failure of absorption e.g. heart failure or nephrotic syndrome.
Unilateral - Factors affecting that specific lung e.g. PE, pneumonia, lung cancer.
How do you diagnose pleural effusion?
History and Examination (sometimes all you need)
Radiology - chest x-ray and CT
Diagnostic aspiration - under US guidance. Send aspirate for:
- Protein content (transudate or exudate)
- Bacterial examination (inc Gram stain) and culture
- Cytolgy
How do you treat patients with a pleural effusion?
- Depends on underlying condition and extent of the pleural effusion
- In very symptomatic patients, chest aspiration may be indicated
- Usually treat the underlying condition
- May require pleurodesis (stick the two pleura together) for recurrent effusions secondary to cancer.
How does knowledge of the protein content of the pleural effusion help aid diagnosis?
Transudate vs Exudate.
Transudate - more likely to be CHF, cirrhosis, nephrotic
Exudate - more likely to be malignancy, infection, sepsis
