Pneumothorax

Question 1

What is pneumothorax?

Answer 1

Pneumothorax occurs when air gets into the pleural space, separating the lung from the chest wall.

Question 2

What are the typical patient characteristics for pneumothorax?

Answer 2

Tall, thin young man presenting with sudden breathlessness and pleuritic chest pain.

Question 3

What are the aetiologies of pneumothorax?

Answer 3

• spontaneous
• trauma
• iatrogenic (e.g. lung biopsy, mechanical ventilation, central line insertion)
• lung pathologies (e.g. infection, asthma, COPD)

Question 4

What is the first choice investigation for simple pneumothorax?

Answer 4

Erect chest x-ray

Question 5

How is the size of pneumothorax measured according to BTS guidelines 2010?

Answer 5

Measure horizontally from lung edge to inside of chest wall at level of hilum.

Question 6

What is the management for pneumothorax with no shortness of breath and <2cm rim of air on CXR?

Answer 6

• No treatment, will resolve spontaneously
• Follow-up in 2-4 weeks

Question 7

What is the management for pneumothorax with shortness of breath or >2cm rim of air on CXR?

Answer 7

• Aspiration followed by reassessment
• Failed aspiration twice ⇒ chest drain

Question 8

What management is required for unstable patients, bilateral, or secondary pneumothoraces?

Answer 8

Usually require a chest drain.

Question 9

Where is a chest drain inserted?

Answer 9

Into the ‘triangle of safety’ formed by:
* 5th intercostal space
* midaxillary line (latissimus dorsi)
* anterior axillary line (pectoralis major)

Question 10

What is the purpose of inserting the needle just above the rib during chest drain insertion?

Answer 10

To avoid the neurovascular bundle.

Question 11

What are some complications of chest drain insertion?

Answer 11

• Air leaks around drain site
• Surgical emphysema

Question 12

When is surgical management indicated for pneumothorax?

Answer 12

• Chest drain fails to correct pneumothorax
• Persistent air leak in drain
• Pneumothorax reoccurs

Question 13

What is the technique used in surgical management of pneumothorax?

Answer 13

Video-assisted thoracoscopic surgery (VATS)

Question 14

What is pleurodesis?

Answer 14

Creating inflammatory reaction in pleural lining so that pleura stick together, sealing pleural space.

Question 15

What are the types of pleurodesis?

Answer 15

• Abrasive pleurodesis (direct physical irritation)
• Chemical pleurodesis (using chemicals, such as talc powder, to irritate pleura)

Question 16

What is pleurectomy?

Answer 16

Removal of the pleura.

Question 17

What causes tension pneumothorax?

Answer 17

Trauma to chest wall, creating a one-way valve.

Question 18

What are the clinical features of tension pneumothorax?

Answer 18

• Tracheal deviation away from side of pneumothorax
• Reduced air entry on affected side
• Increased resonance to percussion on affected side
• Tachycardia
• Hypotension

Question 19

What is the immediate management for tension pneumothorax?

Answer 19

Insert a large bore cannula into the second intercostal space in midclavicular line.

Question 20

What is the definitive management for tension pneumothorax?

Answer 20

Chest drain.