Pneumothorax + pleural disease Flashcards
(36 cards)
Define simple pneumothorax
Presence of air within the pleural space
Air moves in and out
Define tension pneumothorax
- Presence of air within the pleural space
- Air moves in but NOT out
- Increases pressure in pleural space > pushes onto mediastinum
Types of pneumothorax
Simple
Tension
.
Iatrogenic/trauma
Spontaneous - primary or secondary
What are the types of spontaneous pneumothorax?
- primary: no underlying lung disease
- secondary: with existing lung disease
How is inspiration affected in a patient with a pneumothorax?
- 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
Symptoms of pneumothorax
Pleuritic chest pain
Dyspnoea
What is a spontaneous pneumothorax?
Occurs without obvious trauma/iatrogenic
Signs of pneumothorax
Reduced air entry
Hyper resonant
Reduced chest expansion
Diagnosis of pneumothorax
erect chest X ray
CT thorax to detect penumothorax that is too small to be seen on CXR
What are the radiological findings of a simple pneumothorax?
Lung doesn’t fill the whole chest
What would suggest a pneumothorax on percussion of the chest?
Hyper resonant
Management of a pneumothorax
Let the air out:
- needle aspiration
- intercostal chest drain
- pleural vent ambulatory device (outpatient)
.
- smoking cessation
- no flying until 2 week after resolution on CXR
- no scuba diving
BTS guidelines for spontaneous pneumothorax management (depending on risk)
- if asymptomatic/minimal symptoms > conservative care
- if symptomatic, low risk + of sufficient size: needle aspiration or pleural vent ambulatory device > chest drain if fails
- if high risk characteristics e.g hemodynamic instability, hypoxia, underlying lung disease: chest drain
- if persistent or recurrent air leak > video assisted thoracoscopic surgery
Outline a pleural vent ambulatory device
- involves a catheter being inserted into the pleural space attached to a device stuck to the upper chest
- the device allows air to exit but not enter
- patients can wear as outpatients until pneumothorax is resolved
Describe the placement of an intercostal tube in the treatment of pneumothorax
- In the triangle of safety: under armpits at side of chest
- Above the rib to avoid damage to intercostal neurovascular bundle
Borders of the triangle of safety
- anteior: posterior border of pectoralis major
- posterior: anterior border of latissimus dorsi
- inferior: 5th intercostal space (in line with nipples)
- apex at axilla
- in mid axillary line
How do we prevent air entering the drain during treatment of a pneumothorax?
Underwater seal
Hickman valve
Complications of chest drains
- air leaks around drain site
- surgical emphysema: when air collects in SC tissue
- neurovascular damage
Why is a water seal used during chest drains?
To prevent air entering the drain
Describe the clinical features suggestive of a tension pneumothorax
- Pleuritic chest pain
- Dyspnoea
- Tachycardia
- Low BP
- Cyanosis
- Deviated trachea
- Reduced air entry on affected side
Describe the radiological features suggestive of a tension pneumothorax
- Mediastinal shift
- Lung doesn’t fill to edges of ribcage
- tracheal deviation
Treatment of tension pneumothorax
Needle thoracostomy
insert a large bore cannula into the 5th ICS in midaxillary line, above the rib
.
Followed by chest drain in safety triangle
How does a pneumothorax cause a collapsed lung?
- Intrapleural pressure equalises with atmospheric pressure
- This changes the pressure differential between intrapulmonary + intrapleural pressure
- lung collapses due to change in trans pulmonary pressure
Define pleural effusion
Excess fluid in the pleura
