Pneumothorax

Question 1

How can you recognise tension pneumothorax?

Answer 1

Pneumothorax with: 
• Severe respiratory distress
• Tracheal deviation to contralateral side
• Distended neck veins ( JVP)
• Hypotension

Do not perform CXR.
Needs immediate treatment.

Question 2

Causes of pneumothorax

Answer 2

• traumatic: penetrating or non-penetrating chest injuries
• iatrogenic (central venous catheter, thoracentesis, mechanical ventilation with barotrauma)
• spontaneous (no history of trauma)

Primary:
· spontaneous rupture of apical subpleural bleb of lung into pleural space
· predominantly tall, healthy, young males

Secondary:
· rupture of subpleural bleb which migrates along bronchioalveolar sheath to the mediastinum then to the intrapleural space
· necrosis of lung tissue adjacent to pleural surface (e.g. pneumonia, abscess, PCP, lung CA, emphysema)

Question 3

Px of pneumothorax

Answer 3

• can be asymptomatic
• acute-onset pleuritic chest pain, dyspnea
• tachypnea, tachycardia
• tracheal deviation (contralateral deviation in tension pneumothorax)
• ipsilateral diminished chest expansion
• decreased tactile/vocal fremitus
• hyperresonance
• ipsilateral diminished breath sounds

Question 4

Ix of Pneumothorax & what will you see in small & large pneumothorax?

Answer 4

• CXR

- small: separation of visceral and parietal pleura seen as fine crescentic line parallel to chest wall at apex
- large: increased density and decreased volume of lung on side of pneumothorax

Question 5

Rx of pneumothorax

Answer 5

• small pneumothoraces (