Pneumothorax Flashcards
What is it?
Air trapped in the pleural cavity either can be spontaneous, traumatic or iatrogenic
What are the different types of pneumothorax?
- Spontaneous
- Primary- healthy lung (PSP)
- Secondary- have lung pathology (SPP)
- Traumatic
- Iatrogenic
- simple
- TENSION: emergency
What can be the cause of spontaneous pneumothorax?
- some risk factors
- usually due to pleural blebs / bullae
- Lung disease
What are risk factors for pneumothorax?
- Pre-existing lung disease
- young tall male -> flying
- Smoking/ Cannabis (x9)
- Diving
- Trauma/ Chest procedure
- Association with other conditions e.g. Marfan’s syndrome
What iatrogenic causes?
- central lines- femoral, subclavian, jugular veins (Prevent with USS guidance)
- Thoracotomy- surgery on pleura
- Pacemaker fitting- left side preferred
- Ventilation- positive pressure and disease lung can puncture
- Resuscitation
- Lung biopsy
What trauma causes?
- Severe chest wall injury → stab wound or gunshot wound
- Rib fracture
What are other differentials ?
PE - X-Ray changes, auscultation and percussion
Bullae- no collapsed marking, in one area of lung
Surgical emphysema- air in subcutaneous tissue over ribs
What is a tension pneumothorax?
- haemodynamic instability
- caused by the one-way flow of air valve
- causes tracheal deviation (mediastinal deviation- pressing on heart)
Lots of air in the pleural cavity
What symptoms are common in simple ?
chest pain - pleuritic, sudden onset, sharp
SOB
Signs on examination?
- Trachea - deviation in tension
- Chest movement- reduced on affected side
- Hyperresonance- percussion
- Reduced/Loss of breath sounds on pneumothorax side -auscultation
- Vocal resonance- reduced on affected side
Symptoms in tension ?
chest pain - pleuritic, sudden onset, sharp
SOB
+ one of
- resp distress
- cyanosis
- tachycardia
- hypoxaemia
What investigation can be done and in which type of pneumthorax?
Tension- no time for imaging must do emergency decompression
In simple:
- Erect CXR
- CT (GOLD STANDARD)- small pneumothorax
- USS
Why would you see on an erect CXR?
Simple :
- Hyperlucency
- Absent lung markings
- White pleural line
- no midline shift
Tension:
- Hyperlucency
- White pleural line
+ - Tracheal deviation away from affected side [midline shift]
- Depressed hemidiaphragm
- Absent lung markings >3cm
When to use CT ?
detects small pneumothorax not detected by CXR, allows accurate estimation of the size.
- differentiate complex bullous disease from pneumothorax
- emphysema obscuring CXR
- May be used by interventional radiologist to place chest drains in the presence of significant bullae or surgical emphysema.
When is USS used?
typically used in the trauma setting to complete a FAST scan.
Therapeutically may be used to aid drain placement.
