Pneumothorax

Question 1

What is pleura

Answer 1

lining of the lung

Question 2

What is visceral and parietal pleura

Answer 2

visceral- forms the
outer covering of the lung

Parietal- inner lining of chest wall

Question 3

Purpose of pleura

Answer 3

• Allows for optimal expansion and contraction of the
  lungs
• Pleural fluid allows for visceral and parietal pleurae to glide over without friction during respiration

Question 4

What is pneumothorax

Answer 4

’ collapse of lung ‘
- presence of air in pleural space

Question 5

Pathophysiology of pneumothorax

Answer 5

• air enterns due to either hole in lung/pleura or chest wall injury
• intrapleural pressure is negative, leads to air being sucked into cavity
• can lead to partial or total lung collapse

Question 6

Different types of pneumothorax

Answer 6

• primary spontaneous pneumothorax
• secondary spontaneous pneumothorax
• traumatic pneumothorax
• large pneumothorax

Question 7

Common presentation of primary spontaneous

Answer 7

A young, tall, healthy, male presents with sudden onset breathlessness and chest pain

Question 8

Pathogenesis of primary spontaneous

Answer 8

Spontaneous rupture of a subpleural bleb

Question 9

RF for primary spontaeous

Answer 9

Tall, slender, young (aged 20-30)
Smoking
Marfan syndrome
Rheumatoid arthritis
Family history
Homocystinuria
Diving or flying

Question 10

Is there known lung disease in primary spontaneous

Answer 10

no

Question 11

typical presentation of secondary spontaneous

Answer 11

A middle-aged patient with COPD presents with sudden onset breathlessness and chest pain

Question 12

Presence of underlying lung disease in secondary spontaneous?

Answer 12

Yes: occurs due to ruptured bleb or bullae secondary to lung disease

Question 13

Pathogenesis of secondary spontaneous

Answer 13

Rupture of damaged pulmonary tissue

Question 14

RF for secondary spontaneous

Answer 14

Underlying lung disease: COPD, asthma, lung cancer
Tuberculosis
Pneumocystis jirovecii

Question 15

Traumatic causes of a pneumothorax?

Answer 15

• Penetrating chest wall injury
• Puncture from rib
• Rupture bronchus/oesophagus

Question 16

Iatrogenic causes of pneumothorax

Answer 16

‘Doctor induced’
Risk
Pacemakers,
CT lung biopsies,
Central line insertion
Mechanic ventilation
Pleural aspiration

Question 17

What occurs in a tension pneumothorax

Answer 17

• Air is forced to enter the thoracic cavity without any means of escape, resulting in a ‘one-way-valve’

Question 18

Symptoms of pneumthorax

Answer 18

• sudden onset pleuritic chest pain
• sudden onset dyspnoea
• sweating - may be present

Question 19

signs of pneumothorax

Answer 19

• tachycardia and tachypnoea
• cyanosus
• hyperresonance ipsilaterally
• reduced breath sounds ipsilaterally
• ## hyperexpansion ipsilaterally

Question 20

Investigations of PNM

Answer 20

• CXR- first line
• CT CHEST- GS

Question 21

What would a CXR show

Answer 21

• tension pneumothorax , mediastinal shift and tracheal deviation contralterally

Question 22

Management of PNM

Answer 22

• Aspiration is usually performed at the 2nd intercostal space midclavicular line on the affected side, whereas a chest drain is inserted at the 5th intercostal space mid-axillary line on the affected side within the ‘triangle of safety’ alongside high-flow oxygen, with a repeat CXR being performed

Question 23

Overview of management for pnm

Answer 23

No intervention
-Reabsorb spontaneously 2% volume a day
Consider high flow oxygen (10L)
Pleural Aspiration
-Up to 1.5Litre of air can be aspirated
Chest Drain
-Needed for most secondary pneumothoraxes
Surgery
-For persistent and recurrent pneumothorax

Question 24

Conservative measures for pnm

Answer 24

• Stop Smoking
• No Air flight until 6 week after resolution
• No Scuba diving (EVER!)