Pneumothorax and Pleural Effusion Flashcards
Define pneumothorax
The presence of air between the visceral and parietal pleura of the lungs
Where does the air in a pneumothorax come from?
The Lung (most common)
- primary to spontaneous pneumothorax
- Secondary to underlying disease/ trauma
- Iatrogenic- high pressure ventilation, central line placement
Through the chest wall (rare)
- trauma
Both the lung and through chest wall (rare)
- Trauma e.g. penetrating chest injury
What is a primary pneumothorax?
Pneumothorax commonly caused by rupture of a small sub pleural bleb or bulla
What is the usual demographic of a patient with primary pneumothorax?
Young, tall, thin males
No lung disesse or thoracic trauma but smoking increases risk x9
What is secondary pneumothorax?
Occurs secondary to an underlying lung problem
(COPD, asthma, bronchiectasis, cancer, pulmonary infection)
Or, secondary to trauma
What symptoms would you get from the history of someone with a simple pneumothorax?
- sudden onset
- pleuritc chest pain
- breathlessness
- +/- history or lung disease (if secondary)
What signs would you find on examination of a patient with a simple pneumothorax?
- Chest movement reduced on affected side
- Percussion note hyper-resonant on affected side
- Breath sounds reduced/ absent on affected side
- Vocal Resonance reduced
What features of this CXR suggest a pneumothorax?
- Right side is hyperlucent (darker than normal side)
- Absent lung markings on right side (beyond edge of collapsed lung)
- Edge of collapse is seen
What can you see on this CT scan to suggest pneumthorax?
Dark area on the left shows air
How do you treat a pneumothorax (small and large)
Small: needle aspiration
Large: insert chest drain
Where do you place a chest drain if someone has a pneumothorax?
In the safe triangle
- 5th intercostal space
- midaxillary line
- Above 6th rib to avoid neurovascular bundle
What is a tension pneumothorax?
Any size of pneumothorax that causes mediastinal shift and cardiovascular collapse
Explain the pathophysiology of a tension pneumothorax
Occurs when air can enter the pleural cavity on inspiration but cannot escape on expiration
The flap that closes on expiration acts as a one way valve
Why is a tension pneumothorax life threatening?
- Mediastinal shift compresses normal lung
- Increased intrapleural pressure is higher than atmospheric pressure
- Venous return is impaired and cardiac output drops
- Causes hypoxaemia and haemodynamic compromise
What signs and symptoms would indicate a tension penumothorax?
- Severe distress and dyspnoea
- Pleuritic Chest pain
- Fatigue
- Tachycardia and Hypotension
- Raised JVP
- Deviated trachea
- Displaced Apex Beat
- Hyper-resonant percussion
- Absent breath sounds
What features of this CXR suggest tension pneumothorax?
- Trachea deviated to the left
- Heart displaced to left
- Right lung is hyperlucent with absent lung markings
- Edge of collpsed lung visible
How do you treat a tension pneumothorax?
Emergency needle decompression of the chest
Plastic cannula inserted into 2nd ICS, midclavicular line
What is a pleural effusion?
An exess of fluid within the pleural cavity
What is a haemothorax, chylothorax and empyema?
Haemothorax: fluid is blood
Chylothorax: fluid is lymph
Empyema: fluid is pus
How does pleural effusion occur?
When there is an imbalance between the amount of pleural fluid and the absorption via the lymphatics
What is the difference between a pleural effusion transudate and exudate?
Transudate= low protein content
Exudate= high protein content
What are some of the common caues of Pleural effusion Transudate?
- Congestive Heart Failure (most common)- due to increased capillary hydrostatic pressure
- Hypoproteinaemia (reduced colloid oncotic pressure) either by nephrotic syndrome or liver failure
What are some of the common causes of a pleural effusion exudate?
Anything that causes increased capillary permeability due to inflammation:
- Infection: Pneumonia/ TB
- Cancer (primary or secondary or blocks lymphatic drainage
- Pulmonary infarction due to PE
What are the symptoms you would find in the history of someone with pleural effusion?
- Breathlessness (gradual onset over days)
- Chest pain (pleuritic)
- +/- causative disease (congestive heart failure/ lung malignancy)
