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Respiratory System > Pneumothorax + Pleural Disease > Flashcards

Pneumothorax + Pleural Disease Flashcards

1
Q

Define simple pneumothorax

A

Presence of air within the pleural space
Air moves in and out

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2
Q

Define tension pneumothorax

A
  • Presence of air within the pleural space
  • Air moves in but NOT out
  • Increases pressure in pleural space > pushes onto mediastinum
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3
Q

Types of pneumothorax

A

Simple
Tension
.
Iatrogenic/trauma
Spontaneous - primary or secondary

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4
Q

What are the types of spontaneous pneumothorax?

A
  • primary: no underlying lung disease
  • secondary: with existing lung disease
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5
Q

How is inspiration affected in a patient with a pneumothorax?

A
  • air moves into pleura due to lower pressure
  • air in pleura limits expansion of lungs
  • causes higher pressure in lungs
  • so there is a smaller pressure gradient in lungs compared to outside air
  • less air moves into lungs
  • inspiration is impaired
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6
Q

Symptoms of pneumothorax

A

Pleuritic chest pain
Dyspnoea

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7
Q

What is a spontaneous pneumothorax?

A

Occurs without obvious trauma/iatrogenic

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8
Q

Signs of pneumothorax

A

Reduced air entry
Hyper resonant
Reduced chest expansion

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9
Q

What are the radiological findings of a simple pneumothorax?

A

Lung doesn’t fill the whole chest

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10
Q

Treatment of a pneumothorax

A

Let the air out:
- needle aspiration
- intercostal chest drain

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11
Q

Describe the placement of an intercostal tube in the treatment of pneumothorax

A
  • In the triangle of safety: under armpits at side of chest
  • Above the rib to avoid damage to intercostal neurovascular bundle
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12
Q

How do we prevent air entering the drain during treatment of a pneumothorax?

A

Underwater seal
Hickman valve

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13
Q

Describe the clinical features suggestive of a tension pneumothorax

A

Pleuritic chest pain
Dyspnoea
Tachycardia
Low BP
Cyanosis

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14
Q

Describe the radiological features suggestive of a tension pneumothorax

A
  • Mediastinal shift
  • Lung doesn’t fill to edges of ribcage
  • tracheal deviation
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15
Q

Define pleural effusion

A

Excess fluid in the pleura

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16
Q

Define haemothorax

A

Blood within the pleural space

17
Q

Define chylothorax

A

Accumulation of lymph in the pleural cavity

18
Q

Define empyema

A

Collection of pus within the pleural cavity

19
Q

Define parapneumonic effusion

A

Effusion next to pneumonia in the lung

20
Q

Explain the difference between a pleural effusion which is an exudate vs transudate
Examples of when one is more likely

A
  • exudate: higher protein (protein driven) | often associate with inflammation + increased permeability to protein
  • e.g. parapnuemonic effusion, maligancy, TB, Pulmonary infarction from pulmonary embolism
    .
  • transudate: reduced protein (fluid driven)
  • e.g. heart failure, liver failure, kidney failure
21
Q

Examples of causes of transudate pleural effusion

A
  • due to increase pleural capillary hydrostatic pressure - heart failure
  • due to decreased capillary oncotic pressure - liver failure + kidney failure
22
Q

Why is a water seal used during chest drains?

A

To prevent air entering the drain

23
Q

Treatment of pleural effusions

A

Remove the fluid:
- chest drain
- diuresis
- antibiotics: to remove pathogen causing inflammation

24
Q

Treatment of tension pneumothorax

A

Emergency chest drain

25
Q

Examples of causes of exudate pleural effusion

A
  • Parapneumonic effusion (pneumonia)
  • Malignancy
  • TB
  • Pulmonary infarction from pulmonary embolism
26
Q

Borders of the triangle of safety

A
  • anteior: posterior border of pectoralis major
  • posterior: anterior border of latissimus dorsi
  • inferior: 5th intercostal space (in line with nipples)
  • in mid axillary line
27
Q

Is high protein content fluid tranudate or exudate?

A

Exudate

28
Q

How does a pneumothorax cause a collapsed lung?

A
  • Intrapleural pressure equalises with atmospheric pressure
  • This changes the pressure differential between intrapulmonary + intrapleural pressure
  • lung collapses due to change in trans pulmonary pressure
29
Q

Describe the radiological findings of a pleural effusion

A
  • loss of costo-phrenic angle of affected side
  • dense homogenous opacity
  • upper border of effusion higher laterally than medially
  • concave upper border to effusion
30
Q

What would suggest a pneumothorax on percussion of the chest?

A

Hyper resonant

31
Q

What would you find on percussion of pleural effusion?

A

Dull

Respiratory System (20 decks)

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