Pneumothorax

Question 1

What is a Pneumothorax?

Answer 1

Pneumothorax

• Air gains access/ accumulates in pleural space (between visceral and parietal pleura

Question 2

What is a tension Pneumothorax?

Answer 2

Emergency when a functional valve lets air enter the pleural space during inspiration, but not leave during expiration

Question 3

What is the Epidemiolgoy of pneumothorax?

Answer 3

• Spontaneous in about 9 in 100.000
• 20-40
• Male>Female (4:1)

Question 4

What is the aetiology of spontaneous pneumothorax?

Answer 4

Spontaneous, associated with risk factors

• Tall thin males or connective tissue disorder

Question 5

What are secondary pneumothorax?

Question 6

What are traumatic oneumothorax?

Answer 6

Due to trumatic injury

e-g- rib # or Iatrogenic

Question 7

Why is a tension-pneumothorax petentially life-threatening?

Answer 7

collpas of ipsilateral, compression of contralateral lung, trachea, heart, SVC –> reduced resp. Function + reduced venous return –> reduced CO –> hypoxia/haemodynamic instability

Question 8

What are the risk factors for development of a Pneumothorax?

Answer 8

Collagen disorders (e.g. Marfans, Elhlers danlos syndrom etc.), for spontaneous

• Others:
• Smoking (up to 20x risk increase)
• FHx of pneumothorax
• Tall and slender
• <40 years
• Trauma, Recent surgical procedures
• Underlying lung disease: COPD, TB, CF, Asthma

Question 9

What are the symptoms of a pneumothorax?

Answer 9

Asymptomatic if small

Otherwise:

• sudden onset dyspnoea and
• pleuritic chest pain

Question 10

What are the symptoms of a tension pneumothorax?

Answer 10

Tension Pneumothorax

• Distress
• Rapid shallow breathing
• (+ sudden onset dyspnoea + pleuritic chest pain)

Question 11

What are the signs of a pneumothorax on examination?

Answer 11

P-Thorax

• Pleuritic pain
• Tracheal deviation
• Hyperresonance
• Onset sudden
• Reduced breath sounds (and dyspnea)
• Absent fremitus
• X-rays show collapse

+ possible subcuatenous emphysema

Question 12

What are signs of a tension pneumothorax on examination?

Answer 12

Signs of severe pneumothorax +

• Dyspnoea, tachypnoea, shallow
• Tachcardia
• Hypotension
• Cyanosis
• Visible one-sided hyper expansion

Question 13

What are possible differentials for a Pnemothorax?

Answer 13

• Acute exacerbation of Asthma, COPD
• ! PE: Pulmonary Embolism
• Myocardial ischaemia
• Pleural effusion
• Bronchopleural fistula
• Oesophageal perforation
• Giant Bulla

Question 14

What are findings of a pneumothorax on a CXR?

Answer 14

• Dark area of film where lung markings do not extend to chest wall
• Fluid Levels (if blood present)
• Signs of underlying lung disease

Question 15

Which investigations would you do in a patient with possible Pneumothorax?

Answer 15

CXR

ABG: determine severity of pneumothorax/ resp distress

Question 16

What is the management of a tension pneumothorax?

Question 17

What is a small pneumothorax?

What is it’s management?

Question 18

What is the management of a medium Pneumothorax, or a small pneumothorax with clinical compromise?

Answer 18

Moderate Pneumothorax (>2cm lung-pleural margin)

Aspiration of air

Chest drain with water seal

Question 20

What could you consider in a patient with reoccuring pneumothorax/ patient who wants to dive?

Answer 20

Pleurectomy

Question 21

What do patients with pneumothorax need to avoid?

Answer 21

1. Air travel (until CXR confirmed

Question 22

What are complications of Pneumothorax?

Question 23

What is a bronchopleural fistula?

Answer 23

Abnormal passage way between bronchi and pleural space

Question 24

What is the prognosis of a pneumothorax?

Answer 24

20% reocurrence after spontaneous pneumothorax (increaseing with repeated pneumothoraces)