Pneumothorax Flashcards
(34 cards)
What is pneumothorax?
Pneumothorax is a condition characterized by the accumulation of air in the pleural space, resulting in the partial or complete collapse of the affected lung.
What are the classifications of pneumothorax?
Pneumothoraces can be classified as spontaneous pneumothorax, traumatic pneumothorax, and iatrogenic pneumothorax.
What is primary spontaneous pneumothorax (PSP)?
PSP occurs without underlying lung disease, often in tall, thin, young individuals, and is associated with the rupture of subpleural blebs or bullae.
What is secondary spontaneous pneumothorax (SSP)?
SSP occurs in patients with pre-existing lung disease, such as COPD, asthma, cystic fibrosis, lung cancer, or Pneumocystis pneumonia.
What is traumatic pneumothorax?
Traumatic pneumothorax results from penetrating or blunt chest trauma, leading to lung injury and pleural air accumulation.
What is iatrogenic pneumothorax?
Iatrogenic pneumothorax occurs as a complication of medical procedures, such as thoracentesis, central venous catheter placement, ventilation, or lung biopsy.
What is tension pneumothorax?
Tension pneumothorax is a severe pneumothorax resulting in the displacement of mediastinal structures, potentially causing severe respiratory distress and haemodynamic collapse.
What is catamenial pneumothorax?
Catamenial pneumothorax accounts for 3-6% of spontaneous pneumothoraces in menstruating women and is thought to be caused by endometriosis within the thorax.
What are the common symptoms of pneumothorax?
Symptoms tend to come on suddenly and include dyspnoea and chest pain, often pleuritic.
What are the signs of pneumothorax?
Signs include hyper-resonant lung percussion, reduced breath sounds, reduced lung expansion, tachypnoea, and tachycardia.
What are the signs of tension pneumothorax?
In tension pneumothorax, signs include respiratory distress, tracheal deviation away from the side of the pneumothorax, and hypotension.
What did the British Thoracic Society (BTS) publish in 2023?
Updated guidelines for the management of spontaneous pneumothorax.
What is the emphasis of the updated BTS guidelines regarding pneumothorax?
Less emphasis on size and more on patient symptoms and high-risk characteristics.
What is the first step in the decision algorithm for pneumothorax management?
Assess whether the patient is symptomatic.
How does the BTS define minimal symptoms in pneumothorax?
‘No significant pain or breathlessness and no physiological compromise.’
What is the management approach for patients with no or minimal symptoms?
Conservative care, regardless of pneumothorax size.
What should be assessed if a pneumothorax is symptomatic?
Assessment for high-risk characteristics.
What are the high-risk characteristics for pneumothorax?
Haemodynamic compromise, significant hypoxia, bilateral pneumothorax, underlying lung disease, age ≥ 50 with significant smoking history, haemothorax.
What interventions are available if no high-risk characteristics are present?
Conservative care, ambulatory device, or needle aspiration.
What intervention is indicated if high-risk characteristics are present?
Chest drain.
How is the safety of intervention determined for pneumothorax?
Based on clinical context, usually 2cm laterally or apically on chest x-ray, or any size on CT scan accessible with radiological support.
What should be done if needle aspiration of a pneumothorax is unsuccessful?
A chest drain should be inserted.
What is the follow-up procedure after resolving a pneumothorax?
Discharge and follow-up in the outpatients department in 2-4 weeks.
What should be considered for persistent or recurrent pneumothorax?
Video-assisted thoracoscopic surgery (VATS) for mechanical/chemical pleurodesis +/- bullectomy.
