Pneumothorax

Question 1

Definition

Answer 1

Presence of air in the pleural cavity

Question 2

Causes

Answer 2

• Rupture preumatoceles
• Rupture tuberculous cavity
• Rupture lung abscess.
• Rupture surface alveoli in air trapping
• Vigorous resuscitation
• Chest wall trauma

Question 3

Clinical picture

Symptoms

Answer 3

-Asymptomatic (in small pneumothorax) 
🌼 discovered accidentally  
-Symptomatic: 
🌼 Respiratory distress (⬆️⬆️ with tension pneumothorax). 
🌼 Symptoms of the cause

Question 4

Chest examination

Answer 4

🌷
- Inspection → Unilateral decreased movement & unilateral bulge.
- Palpation → Decreased TVF & trachea shifted to opposite side.
- Percussion → Hyper resonance.
- Auscultation → Marked diminished breath sounds.
→ Coin test

🌷 Evidence of tension.
• Mediastinal shift
• Circulatory compromise
• Hearing a “hiss” of rapid exit of air under tension with the insertion of the thoracostomy tube

Question 5

Investigations

Answer 5

• Chest X-ray/CT → jet black opacity ± mediastinal shift to the opposite side
• CT chest: may identify underlying pathology such as blebs
• For the cause

Question 6

Treatment

Answer 6

1- Small pneumothorax: usually resolve within 1 week.

2- Symptomatic:

• Closed drainage with underwater seal.
• Tube is inserted in the 2 nd space mid clavicular line.

3- Treat the underlying cause.