Pneumothorax

Question 1

Causes

Answer 1

1. Spontaneous: young thin men, subpleral bullae rupture
2. Other
   Asthma
   COPD
   TB
   Pneumonia
   Lung abscess
   Carcinoma
   CF
   Lung fibrosis
   Sarcoid
   CT
   Trauma
   Iatropgenic->insertion, biopsy, positive airway pressure

Question 2

Symptoms

Answer 2

May be none
Sudden onset dyspnea
Pleuritic chest pain

Question 3

Signs

Answer 3

Reduced expansion
Hyper-resonance
Diminished breath sounds

Question 4

Investigations

Answer 4

CXR

Question 5

Management

Answer 5

1. If the patient presents with a pneumothorax and BP 2. If the patient is haemodynamically stable, give O2 to maintain O2 saturation
   > 95% (be cautious in patients with COPD).
2. Take a history, including details of previous pnuemothoraces and their side, preexisting
   lung disease, smoking history and previous lung surgery.
3. Perform a chest X-ray to confirm the diagnosis. If the X-ray looks normal, check
   the apices and right heart border and obtain inspiratory films.
4. In patients with no history of lung disease, needle-aspirate the affected lung and
   try to remove as much air as possible. Repeat the chest X-ray to assess progress. If the lung has reinflated fully, repeat the chest X-ray at 7 days to confirm reinflation.
5. Ask the patient to avoid air travel and to return if there is any deterioration of symptoms. If the lung has partially reinflated, consider
   reaspiration and maintain on O2. If the lung has not reinflated, insert a chest drain.
6. In patients with existing lung disease, small apical pneumothoraces can be managed conservatively and with O2. However, if there is a moderate or large pneumothorax, a chest drain should be inserted to prevent respiratory
   compromise.
7. Monitor->BP, RR, HR, oxygen saturation. Beware of deterioration
8. Consider need for admission, consider underlying etiology (esp young male ?marfinoid)