Pneumothorax & Pleural effusion Flashcards
Briefly describe the pathology of a pneumothorax.
- Collapsed lung which occurs when air enters the pleural space (between visceral and parietal space aka intrapleural space)
- causes a loss negative pressure that leads to lung collapse
Briefly describe the pathophysiology of pneumothorax.
- Can be spontaneous or caused by trauma.
- Air that enters the intrapleural space creates a loss of the negative pressure that allows the lungs to recoil –> lung collapse
- pressure on lung can lead to pleuritic chest pain
What are the symptoms of someone with a pneumothorax?
- pleuritic chest pain: pressure against the lung due to air inside chest cavity causes pain
- dyspnoea (decreased TLC due to collapse)
- increased breathing rate (body compensating for lack of oxygen)
- fast heart rate (increased pressure reduces the amount of blood returned to heart, forcing it to work harder)
What might you hear if you auscultated someone with a pneumothorax?
- reduced/absent breath sounds depending on size of pneumothorax (no air movement as lung is not inflated in the area of the collapse)
What features would you see on a CXR?
- clear outline of the visceral pleura of the lung and where air has entered the pleural space.
- blackness in the area where collapse occurred (no air movement).
- mediastinal shift and tracheal deviation as air pushes structures to the other side
- absence of vascular lung markings - because of the blackness of air
What are the PFT findings?
(NOT ROUTINELY TAKEN)
- decreased TLC (lung collapse)
- decreased FVC (decreased TLC)
- decreased FEV1 - decreased compliance of lung
What impairment might this patient have?
Gas movement impairment:
- loss of negative pressure means muscle activity does not produce the same expansion of the lung
- respiratory pump movement decreased due to air in the pleural space (gas movement impaired)
- decreased oxygen and CO2 movement due to pleuritic chest pain (they don’t want to generate inspiratory and expiratory pressure to breathe)
- reduced TLC in lungs means decreased CO2 movement - can’t exhale as effectively
Secretion movement -
- cough inhibition due to pleuritic chest pain
Briefly describe the pathology of pleural effusion.
The build up of excess fluid between the layers of the pleura outside the lung
- small amount of fluid is normal to lubricate lung during inhalation and exhalation
- excess fluid disturbs the equilibrium
Briefly describe the pathophysiology of pleural effusion
- visceral and parietal pleura plays an important role in maintaining fluid balance by producing and absorbing fluid.
- pleural fluid rate exceeds lymphatic removal rate in the pleural cavity.
- pressure on the lungs leads to pleuritic pain leading to cough inhibition and impairment of oxygen and CO2 as muscles don’t want to work as hard to breathe due to pain.
What symptoms might someone with pleural effusion have?
Dyspnea/SOB - effusion makes it harder for the lung to expand and the more difficult it is for the patient to breathe.
Dry cough - inflammation of pleura and pressure on lungs
Chest pain - pleural irritation and pressure on lungs
What might you hear if you auscultated this patient?
- pleural rub: movement of inflamed pleural spaces/ change in fluid in pleural cavity
- reduced/absent breath sounds - increased substance between the lung and the stethoscope
What features might you see on a CXR?
- meniscus sign: fluid tends to rise higher along the edge of the lung making wedged shape
- blunting of costophrenic angle (due to meniscus)
What impairments would someone with a pleural effusion have?
Gas movement impairment:
- disrupts intrapleural pressure meaning lung is stiffer -> air can’t flow in and out as much
- gas movement (oxygen and CO2) impairment as pleuritic pain means patients don’t want to generate pressure to breathe as deeply.
