Pneumothorax

Pathology:                    

Definition: The presence of air in thepleural cavity

Spontaneous Pneumothorax:

Primary(occurring in otherwise healthy patients) or        

Secondary (associated with underlying lungdisease)

Open Pneumothorax: Chest woundthat sucks in air causing tension pneumothorax

Tension Pneumothorax: One-wayvalve develops allowing air into the pleural space

Intrapleural pressurerises, venous return is impaired

facilitating hypoxaemia and haemodynamicinstability

Aetiology:                    

Primary Spontaneous: smoking, tallerpatients

Secondary Spontaneous: COPD, asthma, pulmonary fibrosis

Trauma: blunt and penetrating chest trauma

Iatrogenic: invasive ventilation, post-chestdrain, post-central line insertion

Symptoms:                  

Chest pain, dyspnoea

Signs:                              

Simple Pneumothorax: Reduced chestexpansion, reduced breath sounds, hyper-resonant percussion note

Tension pneumothorax: cyanosis,severe tachypnoea, tachycardia and hypotension, mediastinalshift away from affected side

Investigations:          

Chest X-Ray: Aids diagnosis and sizing

CT: Useful for uncertainty or complex cases

Treatment:                  

Spontaneous pneumothorax: Air aspiration or discharge and monitor

Tension pneumothorax: Immediate needle decompression into 2^ndintercostal  

space in themid-clavicular line then chest drain insertion

Open pneumothorax: Occlusivedressing applied and taped down on three sides to

                                               allow air to escape preventing a tensionpneumothorax.

Surgical input: Used in persistent air-leak; Open thoracotomyor pleurectomy.  

                              Chemical pleurodesis is used forthose who cant tolerate surgery.

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Complications:          Reoccurrence,persistent air leak, re-expansion pulmonary oedema

Prognosis:                    Reoccurrencerate in primary spontaneous 28-32% and secondary spontaneous 43%

Figure 2.4 Left tension pneumothorax