Pneumothorax

Question 1

Pneumothorax definition

Answer 1

Presence of air in the pleural cavity with partial or total collapse of lung

Question 2

3 main types of pneumothorax

Answer 2

Spontaneous
Traumatic
Iatrogenic

Question 3

What is primary spontaneous pneumothorax

Answer 3

Pneumothorax that occurs without precipitating event in a person does not have known lung dx

Question 4

Main location of rupture in primary spontaneous pneumothorax

Answer 4

Rupture of subpleural blebs especially at the apices of lungs

Question 5

Main population at risk of PSP

Answer 5

Young male with tall and thin aesthenic physic

Question 6

Pathophysiology of spontaneous pneumothorax

Answer 6

From expansion of alveoli beneath pleura
Leading to rupture of alveolar walls and overlying pleura

Question 7

What is the mechanism of tension pneumothorax

Answer 7

Valve like mechanism where air enters during inspiration but cannot leave during expiration
Tension build sup

Question 8

X ray findings of tension pneumothorax

Answer 8

Partial or complete collapse of lung towards hilum
Increased translucency
Absence of lung markings in greater part of i psi lateral hemithorax
Mediastinal shift to contralateral side
Ipsilateral diaphragmatic depression
Ipsilateral increase in intercostal spaces
Increased vascularity of contralateral lung

Question 9

Secondary spontaneous pneumothorax causes

Answer 9

COPD
Pulmonary tuberculosis
Enterogenous cyst
RDS of newborn
Pulmonary neoplasm
Bullous lung dx

Question 10

What is traumatic pneumothorax

Answer 10

Caused by penetrating or blunt trauma to chest with air entering pleural space

Question 11

Different ways air enter pleural space in traumatic pneumothorax

Answer 11

Directly through chest wall
Through visceral pleural penetration
Through Alveolar rupture resulting from sudden chest compression

Question 12

Which type of pleural effusion is often associated with traumatic pneumothorax

Answer 12

Hemothorax

Question 13

Event leading to haemo -pneumothorax

Answer 13

Rib fractures
Penetrating chest wound
Perforating chest wounds
Surgical procedures in chest cavity including oesophagus

Question 14

Definition of iatrogenic pneumothorax

Answer 14

Pneumothorax after Complication of diagnostic or therapeutic intervention

Question 15

Main causes of iatrogenic pneumothorax

Answer 15

Subclavian percutaneous catheterisation (central lines, pacemaker insertion )
Transthoracic lung biopsies
Trans bronchial lung biopsies
Thoracocentesis
Chest tube malfunction

Question 16

Population at risk of catamenial pneumothorax

Answer 16

Women 30-40 yo

Question 17

What is catamenial pneumothorax

Answer 17

Cyclical chest pain from presence of endometrial tissue in pleural space

Question 18

what do the symptoms start in catamenial pneumothorax

Answer 18

Within 48h of menstruation

Question 19

Main symptoms in catamenial pneumothorax

Answer 19

Right sided chest pain
Shortness of breath

Question 20

Conditions associated with catamenial pneumothorax

Answer 20

Endometriosis
Infertility

Question 21

What is persistent pneumothorax

Answer 21

Continued air leak from an in situ chest drain more tan 48h after insertion

Question 22

Main causes of persistent pneumothorax

Answer 22

Kinking of the tube
Malposition of tube
Lung parenchymal tube
Bronchopleural fistula
Oesophageal pleural fistula

Question 23

Consequence of pneumothorax in healthy lungs

Answer 23

Partial or total collapse of lung
Minimal arterial hypoxemia
Diminished exercise tolerance

Question 24

Consequence of tension pneumothorax

Answer 24

Mediastinal shift to contralateral side
Compression of lung
Impairment of venous return to heart and severe ventilation perfusion defect

Question 25

When can pneumothorax result in acute respiratory failure

Answer 25

Obstructive airway Severe pulmonary dx

Question 26

History of pneumothorax

Answer 26

Chest pain - sharp, stabbing, on the side of chest involved Dyspnea with cyanosis , sweating. Faintness

Question 27

Respiratory Examination findings in pneumothorax

Answer 27

Respiratory distress Tachypnoea Asymmetric lung expansion Mediastinal and tracheal shift (tension pneumothorax ) Distant / absent breath sounds Hyperresonance Decreased tactile fremitus Adventitious lung sounds (crackles , wheeze)

Question 28

Cardiovascular exam findings

Answer 28

Pulsus paradoxus Hypotension JVD Cardiac apical displacement Tachycardia

Question 29

Investigation

Answer 29

Chest xray Ct scan

Question 30

Treatment of small pneumothorax

Answer 30

If less than 1.5cm, no distress of patient -> Allow spontaneous reabsorption With serial xray to follow progression Heimlich valve with one way disposable one way valve for self limiting pneumothorax

Question 31

Treatment tension pneumothorax

Answer 31

Wide bore intercostal catheter connected to underwater seal and suction Done in 2nd intercostal space anterior , mid clavicular line

Question 32

Function of treatment with chemical pleurodesis

Answer 32

Achieve adhesion between parietal and visceral layer of pleura

Question 33

Chemical used in chemical pleurodesis for adhesion of parietal and visceral pleural layers

Answer 33

10% silver nitrate Iodized talc powder 50% glucose though thoracospe into pleural space Bleomycin in malignancies

Question 34

Indication for surgery in pneumothorax

Answer 34

Persisten air leak 2nd recurrence Contralateral pneumonectomy Contralateral diseased lung Specialized occupation - pilot , deep sea diver Remote from reasonable medical care

Question 35

Contraindications to VATS

Answer 35

Chronic pneumothorax with restrictive membrane over visceral pleural that can interfere with full re expansion of lung