Pneumothorax

• Pathophysiology:

  • A collapsed lung
  • Refers to air in the pleural cavity
  • The presence of air at atmospheric pressure in the pleural cavity and the separation of the pleural membranes by air prevent expansion of the lung, leading to atelectasis
  • When caused by a malignant tumor or trauma, fluid or blood may also be present in the cavity
• Closed - Types:

  • Spontaneous, idiopathic
  • Ruptured emphysematous bleb
  • Air entry: from inside lung through tear in visceral pleura
• Open - Types:

  • Puncture wound through chest wall
  • Air entry: from outside body through opening in thorax and parietal pleura
• Tension - Types:

  • Open: puncture through thorax
  • Closed: tear in lung surface
  • Both with flap or one-way valve
  • Air entry: through the thorax or tear in lung surface
• Signs for all three types - Clinical Manifestations:

  • Increased, labored respirations with dyspnea
  • Tachycardia
  • Pleural pain
  • Asymmetric chest movements
• Closed - Clinical Manifestations:

  • Breath sounds absent
  • Hypoxemia
• Open - Clinical Manifestations:

  • "Sucking" noise if large
  • Tracheal swing
  • Decreased blood pressure
  • Moderate hypoxemia
• Tension - Clinical Manifestations:

  • Breath sounds absent on affected side
  • Tracheal deviation to unaffected side
  • Increased respiratory distress
  • Shock, distended neck veins, cyanosis
  • Severe hypoxemia
• Risk Factors:

  • Smoking
  • COPD
  • Asthma
  • Tuberculosis
  • Males
  • Changes in atmospheric pressure
  • Family history