Pneumothorax

Question 1

Definition of pneumothorax

Answer 1

“Air in the pleural space”

Question 2

What is a primary spontaneous pneumothorax?

Answer 2

Pneumothorax that happens in the absence of a precipitating cause e.g.
- Increased incidence in tall, male and those with Marfans/Ehlers-Danlos

Question 3

What is a secondary spontaneous pneumothorax?

Answer 3

• Occurs in the presence of underlying lung disease usually COPD

Question 4

What is a tension pneumothorax?

Answer 4

Continued accumulation of air through a defect
- can be due to a blunt or penetrating chest injury

Question 5

Symptoms of pneumothorax

Answer 5

• SOB that can be acute onset
• Can be exertional or at rest
• Pleuritic chest pain with minimal radiation

Question 6

Investigations of Pneumothorax

Answer 6

Erect CXR, as the air rises above the apex so it is easier to see

CT can be used for complex cases to visualise bullous lung disease and can be used to calculate the size of pneumothorax

Question 7

Management of a primary pneumothorax that is symptomatic and >2cm in size

Answer 7

Aspirate 16-18G cannula, if successful discharge and review in 2-4 weeks

Question 8

Mx of secondary pneumothorax over 2cm in size and breathlessness

Answer 8

Chest drain (8-14F)
Admission inpatient

Question 9

Mx of secondary pneumothorax under 2cm

Answer 9

Aspirate 16-18G cannula

Question 10

If after aspiration of a >2m secondary pneumothorax, the PTX is less than 1cm, what is the management?

Answer 10

• admission
• high flow oxygen
• observe for 24 hours