Pneumothorax And Pleural Effusion Flashcards
What is a pneumothorax
• Collapsed lung • Air ‘leak’ between the lung and the chest wall (pleural space) • Varying severity • Tension = medical emergency Can be fatal if left untreated
What ae the symptoms and signs of pneumothorax
Symptoms:
Breathlessness, pleuritic chest pain, cough, usually sudden onset o
Signs:
Dyspnoea, tachycardia and hypotension (if severe), reduced unilateral lug expansion, resonant percussion, quiet or absent breath sounds
Describe the cxr for pneumothorax
Ss
Desribe the ct for pneumothorax
Ss
Where can the air come form on a pneumothoax?
• The lung (commonest by far)
– Primary
– Secondary to underlying lung disease or trauma
– Iatrogenic
– high pressure ventilation
• Through the chest wall (rare)
– Trauma
– Iatrogenic (insertion of CVP line in neck, fine needle aspiration of
breast)
• Both the lung and through the chest wall (rare)
– Trauma e.g. stabbing
Describe teh typical presentation of primary pneumothorax
• Most common in young, tall, thin men
• Smoking increases risk by 9x
• Most cases probably have a small sub-pleural bulla (an air filled sac) that bursts, allowing air into the pleural cavit
A sub-pleural bulla – not a small one! - bursts leadin to pneumothorax
Describe a secondary pneumthorax
• Secondary to underlying lung disease:
– COPD
– Asthma
– Bronchiectasis including cystic fibrosis
– Lung cancer
– Pulmonary infections including pneumonia and TB
• Secondary to trauma
– 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
(More significant sharp may have lung and heart problems )
• Secondary to high pressure ventilation
What is a tension pneumothorax
• A tension pneumothorax occurs whenever air can enter
the pleural cavity (either from the chest wall or the visceral pleura) …….
• but cannot escape because of a flap that closes on
expiration. This acts like a one-way valve.
• This is life threatening! Flap
What are symptoms and signs of a tension neumothorax
- Severe distress and dyspnoea
- Pleuritic chest pain
- Fatigue
- Tachycardia and hypotension
- Raised JVP
- Deviated trachea
- Displaced apex beat
- Increased percussion note
- Silent breath sounds
Desribe a tension pneumothorax cxr
Ss
Describe the emergency treatment of a tension pneumothorax
Insert a plastic cannula (Venflon) into the second intercostal space in the mid-clavicular line
Immediate
Why does pleural effusion occur
• Normally 2400 ml of pleural fluid is produced
each day by the parietal pleura
• This is normally absorbed by the visceral pleura and lymphatics
• A pleural effusion occurs when there is dysfunction of either production or absorption
What can cause failure of absotiop
• Failure of absorption most commonly due to
hypoproteinaemia (Low protein state - not made ore excreted - can lead to ascites or pleural effusion):
– Liver failure (cirrhosis)
– Nephrotic syndrome
• Failure of absorption could be due to
congestive heart failure (increased pressure in venous end of capillary)
• Failure of absorption can be due to lymphatic obstruction (cancer)
Why can over production of pleural fluid occur
• Over production of pleural fluid occurs due to
increased capillary permeability
• This is usually due to inflammation:
– Infection (pneumonia, pleurisy, TB)
– Cancer (primary or secondary)
– Pulmonary infarction due to pulmonary embolism
What a re the symptoms and signs of pleural effusion
Syptoms: breathlessness, chest pain cough,
Usually gradual onset and depend on size
Symptoms relating to underlying cause (eg haemoptysis and weight loss - lung cancer)
Signs o a large effusion: dyspnoea, trachea deviation, reduced unilateral lug expansion, stony dull percussion, quiet breath sound, reduced vocal resonance,
Sings of underlying cause eg ankle failure and raised MVP - rhs heart failure
