Introduction
A pneumothorax is a collection of air in the pleural space. They can be:
- Primary – no underlying lung disease. Typically, tall thin young men might have a spontaneous pneumothorax
- Secondary – to underlying lung disease - such as COPD
They can be divided into:
Standard or simple pneumothorax
- Air in the pleural space, but the volume is not increasing.
- On CXR: trachea is not deviated. Lung collapse may be visible (sometimes subtle – decreased vascular markings around the outer lung field)
- spontanous pneumothroax typically occurs in THIN + TALL YOUNG men due to rupture of pleural bleb - the bleb is from congenital defect in the CT tissue of the alveolar wall.
Tension pneumothorax – LIFE THREATENING
- Air in the pleural space, and the volume continuing to increase. Typically due to the formation of a one-way valve, allowing air into the pleural space on inspiration, but not out again on expiration.
- On CXR – the trachea may be deviated away from the side of the pneumothorax. Lung collapse likely to be more obvious.
clinical features tension pneumothorax:
!) Plueritic
chest pain
2)
Breathlessness
3)large pneomothroax = reduced breath sounds affected area and hyper-resonant on percussion.
comlication:
1) it can compress the mediastinum = Decrease Cardiac Output (compressed heart) , increase Heart Rate, Jagular vien distension
INVESTIGATION:
1) Its a clinical Diagnosis
2) if on the X-ray there is LARGE bleb or not sure if its a pheomothorax....then Get CT scan to make sure its not BLEB to save the patient a pontentially dangerous needle aspiration. (BLEB needs surgical resection)
Emergency Treatment
Standard Pneumothorax – must do CXR first before attempting to treat!
Rim of air <2cm – consider alternate diagnosis, OR small pneumothorax that will resolve with conservative management.
- discharge on advice - dont do strenuous exercise - and return if Breathless.
- oberserve at 2 weekly until air is reasorped
Primary Pneumothorax - SOB + rim of air >2cm on CXR:
- Attempt aspiration – 2ND INTERCOSTAL SPACE, MIDCLAVICULAR LINE!
- If unsuccessful, repeat
- If unsuccessful, consider chest drain
Secondary Pneumothorax - SOB + rim of air >2cm on CXR
Tension Pneumothorax
- If suspected, attempt to aspirate before CXR. Use a large bore needle with syringe, filled with saline, to act as a water seal, when entering the pleural space.
if pneumothorax remains at 48 hours or patient has reccurent episodes then do >>> Pleurectomy.
- See more at: http://almostadoctor.co.uk/content/systems/-respiratory-system/pneumothorax#sthash.mSlegPQR.dpuf
