Pleural space Flashcards

Pneumothorax, pleural effusion (29 cards)

1
Q

What is a pneumothorax?

A

A condition characterised by the accumulation of air in the pleural space, resulting in partial or complete collapse of the affected lung.

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2
Q

How is pneumothorax classified?

A
  • Spontaneous pneumothorax
  • Traumatic pneumothorax
  • Iatrogenic pneumothorax
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3
Q

What is a primary spontaneous pneumothorax ?

A

Occurs without underlying lung disease, often in tall, thin, young individuals, and is associated with the rupture of subpleural blebs or bullae

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4
Q

What is a secondary spontaneous pneumothorax ?

A
  • Occurs in patients with pre-existing lung diseases such as COPD, asthma, cystic fibrosis, lung cancer, and Pneumocystis pneumonia
  • Certain connective tissue diseases, like Marfan’s syndrome, are also risk factors
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5
Q

What is a traumatic pneumothorax?

A

pneumothorax resulting from penetrating or blunt chest trauma, leading to lung injury and pleural air accumulation

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6
Q

What is a iatrogenic pneumothorax?

A

Occurs as a complication of medical procedures such as thoracentesis, central line insertion, ventilation (inc NIV) or lung biopsy

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7
Q

What are common symptoms of pneumothorax?

A
  • Sudden dyspnoea
  • Pleuritic chest pain
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8
Q

What are common signs of pneumothorax?

A
  • Hyper-resonant lung percussion
  • Reduced breath sounds
  • Reduced lung expansion
  • Tachypnoea
  • Tachycardia
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9
Q

How is a pneumothorax investigated

A
  • erect chest x-ray - absence of lung markings between lung margin and chest wall
  • CT chest if diagnosis uncertain
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10
Q

What are considered minimal symptoms in pneumothorax?

A

No significant pain or breathlessness, and no physiological compromise

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11
Q

What is the management for a patient with minimal symptoms of pneumothorax?

A

Conservative care, regardless of pneumothorax size

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12
Q

What are the high-risk characteristics for a symptomatic pneumothorax?

A
  • Haemodynamic compromise (suggesting tension pneumothorax)
  • Significant hypoxia
  • Bilateral pneumothorax
  • Underlying lung disease
  • ≥ 50 years old with significant smoking history
  • Haemothorax
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13
Q

What is the next step for symptomatic pneumothorax patients with no high-risk factors

A

patients are offered a choice based on main priority:
* procedure avoidance - conservative
* rapid Sx relief (outpatient) - ambulatory device
* needle aspiration

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14
Q

What is the management if high-risk characteristics are present and it is safe to intervene?

A

Chest drain insertion

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15
Q

How is the safety of intervention for pneumothorax determined?

A

Safety is assessed based on the clinical context, usually:
* >2cm laterally or apically on chest x-ray
* any size on CT

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16
Q

What is the follow-up for patients managed conservatively for primary spontaneous pneumothorax?

A

Review every 2-4 days as an outpatient

17
Q

What is the follow-up for patients managed conservatively for secondary spontaneous pneumothorax?

A

Monitor as an inpatient, then follow up in the outpatient department in 2-4 weeks if stable.

18
Q

What is the purpose of the one-way valve in ambulatory devices for pneumothorax?

A

To prevent air and fluid from returning to the pleural space while allowing for controlled escape of air and drainage of fluid

19
Q

What is the next step if needle aspiration of a pneumothorax is unsuccessful?

A

A chest drain should be inserted

20
Q

Which patients may require surgical intervention for pneumothorax

A
  • persistent air leak in the drain
  • recurrent pneumothorax
  • insufficient lung reexpansion
21
Q

What is the management for persistent or recurrent pneumothorax?

A

Video-assisted thoracoscopic surgery (VATS) with possible mechanical/chemical pleurodesis ± bullectomy.

22
Q

What is tension pneumothorax?

A

A life-threatening condition characterised by the accumulation of air in the pleural space under positive pressure

23
Q

What are the causes of tension pneumothorax?

A
  • Traumatic: Penetrating or blunt chest trauma
  • Iatrogenic
  • Spontaneous
24
Q

What is the pathophysiology of tension pneumothorax?

A
  • Air enters the pleural space and is unable to escape, creating a one-way valve effect
  • This leads to increased intrapleural pressure, causing lung collapse, mediastinal shift, impaired venous return, and reduced cardiac filling.
25
What are the symptoms of tension pneumothorax
* acute onset of dyspnoea * pleuritic chest pain * tachypnoea
26
What are the signs of tension pneumothorax
* hyperresonance on percussion on affected side * reduced breath sounds on affected side * tracheal deviation away from affected side * tachycardia * hypotension
27
Why does hypotension occur in tension pneumothorax
result of cardiac outflow obstruction
28
How is tension pneumothorax diagnosed?
Ideally diagnosed clinically; emergency treatment should not await confirmation from imaging.
29
How is a tension pneumothorax managed
Immediately decompressed with a needle * followed by chest drain