Pneumothorax (pathology)

Question 1

What is a pneumothorax?

Answer 1

Collection of air in pleural space

Question 2

What is a spontaneous pneumothorax?

Answer 2

due to weak area on lung surface-BLEB (small blister <2cm) —> rupture, leak air into pleural cavity

Question 3

What is a primary spontaneous pneumothorax?

Answer 3

In someone with healthy lungs - at apex

Question 4

What is a secondary spontaneous pneumothorax?

Answer 4

Pre-existing condition (COPD-periacinar emphysema- asthma, CF)

Question 5

What is a traumatic pneumothorax?

Answer 5

Blunt trauma - rib fracture/knife injury

Question 6

What is a iatrogenic pneumothorax?

Answer 6

Insertion of central venous line, post biopsy, on ventilator

Question 7

What is an open pneumothorax?

Answer 7

physical hole in chest > ½ tracheal diameter (index finger)
• Impalement injuries or animal bites
• Rag soaked in water over hole to prevent air drawn in from atmosphere, but air still goes out

Question 8

What is a recurrent vs persistent pneumothorax?

Answer 8

Recurrent (> 1 occasion) vs persistent (air leaks in chest drain 7 days post insertion)

Question 9

What is a spontaneous hemopneumothorax?

Answer 9

previous pneumothorax- vascular adhesions- bleeding

Question 10

What is a tension pneumothorax?

Answer 10

tension pneumothorax -> medical emergency

• Air goes in but cannot go out-> pressure pushes mediastinal structures (heart, great vessels, trachea)
• ↓ BP ↓O2= cardiopulmonary arrest
• Common with traumatic p./artificial ventilation

Question 11

What is a bleb vs a bulla?

Answer 11

Bleb <2cm

Bulla >2cm

Question 12

What is the presentation of a pneumothorax?

Answer 12

• sudden event
• sharp chest pain on inspiration
• SOB
• tall thin young man
• might have underlying lung disease
• history of biopsy/line insertion/mechanical ventilation

Question 13

What is found on examination of pneumothorax?

Answer 13

• Tachypnoeic
• Hypoxic
• Reduced chest wall movement
• Reduced/no breath sounds
• Hyper resonant note on percussion

Might be normal
Restrictive pulmonary function

Question 14

Investigation of pneumothorax

Answer 14

CXR- first line

US- if patient too sick
CT thorax

Question 15

Management of pneumothorax

Answer 15

• Observe if small and patient is well
• Aspiration: >2 cm -patient well- green needle + syringe= suck air out
• Chest drain: large pneumothorax/secondary pneumothorax -> small PVC tube under local anaesthetic -> creates channel and removes air
• Surgery for recurrent/unresolving events
- 25-50% risk of recurrence within 1st year
- Talc pleurodesis/ pleurectomy

Question 16

What is the triangle of safety of a pneumothorax

Answer 16

• Pleural aspiration/drain
• 2nd intercostal space midclavicular line

Lateral border of pectoralis major, border of latissimus dorsi, 5th intercostal space (nipple)