Pneumothorax

Question 1

What is the definition of a pneumothorax?

Answer 1

Air in the pleural space leading to partial or complete collapse of the lung

Question 2

How common is a pneumothorax?

Answer 2

Primary spontaneous pneumothorax: 24/100000 a year in men and 9.9/100000 in woman in England

Question 3

What is the pathology of a pneumothorax?

Answer 3

(see sheet for x rays)
• Tension pneumothorax:
• Air passes in during inspiration but unable to exit during expiration
• Unilateral ↑ in intrapleural pressure

Question 4

What are the risk factors/aetiology of a pneumothorax?

Answer 4

• Young men that are tall and thin e.g. Marfans – rupture of pleura due to congenital defect in connective tissue of the alveolar wall
• Spontaneous
• Underlying lung disease e.g. COPD
• Mechanical ventilation – tension pneumothorax
• Nasal non invasive ventilation – tension pneumothorax

Question 5

What are the signs/symptoms of a pneumothorax?

Answer 5

•	Sudden onset of pleuritic chest pain
•	Sudden onset of breathlessness
•	↓ breath sounds
•	Hyperresonant percussion  
Tension = tracheal deviation
•	Sweating
•	Distressed patient 
•	Tachycardic

Question 6

What diseases present similarly to a pneumothorax?

Answer 6

• Pleural effusion
• Chest pain
• PE

Question 7

What investigations are required to diagnose a pneumothorax?

Answer 7

• Tension = clinical
• CXR
• CT – differentiates emphysematous bullae from pneumothoraces

Question 8

What information should a patient with a pneumothorax be given about flying and driving?

Answer 8

Patients are advised not to fly for 2 weeks after successful treatment
Patients are advised not to dive unless surgery is performed to prevent recollapsing of the lung

Question 9

What are the surgical treatments for pneumothorax?

Answer 9

• Tension pneumothorax:
• Immediate decompression by needle thoracocentesis (2nd intercostal space, mid clavicular line)
• Intercostal tube drainage
• Aspiration of air
• Pleurectomy – removal of pleura
• Pleurodesis – pleural space is artificially obliterated

Question 10

What are the pharmacological treatments for pneumothorax?

Answer 10

• High flow oxygen

Question 11

What are the non pharmacological treatments for pneumothorax?

Answer 11

• Avoid strenuous activity

* Smoking cessation