5. Pleural Diseases Flashcards
Pneumothorax, pleural effusion (29 cards)
What is a pneumothorax?
A condition characterised by the accumulation of air in the pleural space, resulting in partial or complete collapse of the affected lung.
How is pneumothorax classified?
- Spontaneous pneumothorax
- Traumatic pneumothorax
- Iatrogenic pneumothorax
What is a primary spontaneous pneumothorax ?
Occurs without underlying lung disease, often in tall, thin, young individuals, and is associated with the rupture of subpleural blebs or bullae
What is a secondary spontaneous pneumothorax ?
- 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
What is a traumatic pneumothorax?
pneumothorax resulting from penetrating or blunt chest trauma, leading to lung injury and pleural air accumulation
What is a iatrogenic pneumothorax?
Occurs as a complication of medical procedures such as thoracentesis, central line insertion, ventilation (inc NIV) or lung biopsy
What are common symptoms of pneumothorax?
- Sudden dyspnoea
- Pleuritic chest pain
What are common signs of pneumothorax?
- Hyper-resonant lung percussion
- Reduced breath sounds
- Reduced lung expansion
- Tachypnoea
- Tachycardia
How is a pneumothorax investigated
- erect chest x-ray - absence of lung markings between lung margin and chest wall
- CT chest if diagnosis uncertain
What are considered minimal symptoms in pneumothorax?
No significant pain or breathlessness, and no physiological compromise
What is the management for a patient with minimal symptoms of pneumothorax?
Conservative care, regardless of pneumothorax size
What are the high-risk characteristics for a symptomatic pneumothorax?
- Haemodynamic compromise (suggesting tension pneumothorax)
- Significant hypoxia
- Bilateral pneumothorax
- Underlying lung disease
- ≥ 50 years old with significant smoking history
- Haemothorax
What is the next step for symptomatic pneumothorax patients with no high-risk factors
patients are offered a choice based on main priority:
* procedure avoidance - conservative
* rapid Sx relief (outpatient) - ambulatory device
* needle aspiration
What is the management if high-risk characteristics are present and it is safe to intervene?
Chest drain insertion
How is the safety of intervention for pneumothorax determined?
Safety is assessed based on the clinical context, usually:
* >2cm laterally or apically on chest x-ray
* any size on CT
What is the follow-up for patients managed conservatively for primary spontaneous pneumothorax?
Review every 2-4 days as an outpatient
What is the follow-up for patients managed conservatively for secondary spontaneous pneumothorax?
Monitor as an inpatient, then follow up in the outpatient department in 2-4 weeks if stable.
What is the purpose of the one-way valve in ambulatory devices for pneumothorax?
To prevent air and fluid from returning to the pleural space while allowing for controlled escape of air and drainage of fluid
What is the next step if needle aspiration of a pneumothorax is unsuccessful?
A chest drain should be inserted
Which patients may require surgical intervention for pneumothorax
- persistent air leak in the drain
- recurrent pneumothorax
- insufficient lung reexpansion
What is the management for persistent or recurrent pneumothorax?
Video-assisted thoracoscopic surgery (VATS) with possible mechanical/chemical pleurodesis ± bullectomy.
What is tension pneumothorax?
A life-threatening condition characterised by the accumulation of air in the pleural space under positive pressure
What are the causes of tension pneumothorax?
- Traumatic: Penetrating or blunt chest trauma
- Iatrogenic
- Spontaneous
What is the pathophysiology of tension pneumothorax?
- 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.
