Pneumothorax

• What is a pneumothorax?


  Presence of air within pleural space → disrupts negative intrapleural pressure → partial or complete lung collapse
• What is a primary spontaneous PTX?


  No underlying lung disease

  Stereotypically occurs in tall, thin, young smokers
• What is a secondary spontaneous PTX?


  Underlying lung disease (COPD, asthma, cystic fibrosis, lung cancer)
• What is a traumatic PTX?


  Results from penetrating or blunt chest trauma

  Lung injury & pleural air accumulation
• What is an iatrogenic PTX?


  Complication of medical procedure
• What is a tension PTX?


  Pneumothorax with haemodynamic compromise
• Pathophys of PTX


  Damage to either visceral or parietal pleura (can occur due to direct trauma, underlying lung disease, or iatrogenic causes such as invasive procedures) → air from alveoli or atmosphere enters intrapleural space → disruption of negative pressure within pleural space (vital for lung expansion during inspiration) → as air continues to enter intrapleural space with each breath & unable to exit efficiently → progressive compression & subsequent collapse of affected lung
• What are the Inx for PTX?


  Obs

  Full Hx & examination

  ECG

  Bloods (FBC, U&Es, LFTs, CRP, Coag, ABG (if have an O2 requirement))

  CXR

  CT thorax
• What is the gold standard for PTX diagnosis?


  CT thorax

  BUT not necessary for diagnosis
• What is the difference between a large & small PTX?


  Small PTX is < 2cm on PA film

  Large PTX is > 2cm on PA film
• What are the DDx of PTX?

  Acute exacerbation of asthma/COPD

  PE

  Myocardial ischaemia

  Pleural effusion

  Bronchopleural fistula

  Fibrosing lung disease

  Oesophageal perforation

  Giant bullae
• What are the RFs of PTX?


  Smoking

  FHx

  Tall & slender build

  Age < 40

  Recent invasive medical procedure

  Chest trauma

  Acute severe asthma

  COPD

  TB

  Cystic fibrosis
• What are the signs & symptoms of PTX?


  Sudden onset dyspnoea

  Pleuritic chest pain

  Non-productive cough

  Decreased breath sounds

  Hyperresonance to percussion

  Tachypnoea

  Low O2 sats

  Tachycardia

  Hypoxia (large/tension PTX)
• What are the specific signs & symptoms for tension PTX?


  Decreased chest wall expansion

  Tracheal deviation

  Severe resp distress

  Jugular venous distension

  Haemodynamic instability
• What are the possible complications of PTX?


  Infection (due to invasive procedures)

  Bleeding

  Recurrence

  Re-expansion pulmonary oedema (rare, but potentially fatal)

  Subcutaneous emphysema (infiltration of air in subcutaneous layer of skin)
• ADD TREATMENT
• Fill in the blanks

  A) Conservative care

  B) Ambulatory device

  C) Needle aspiration

  D) Chest drain

  
• What are the high risk characteristics in PTX?

  Haemodynamic compromise

  Significant hypoxia - new O2 requirement

  Bilateral pneumothorax

  Underlying lung disease

  Over 50 & positive smoking Hx

  Haemopneumothorax