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Pneumothorax

Title               

Ñ    Pneumothorax

Definition

Pneumothorax refers to:

Ñ    Air in the pleural space

Pathogenesis

The causes of pneumothorax may be classified as:

Ñ    Traumatic

Ñ    Spontaneous

Spontaneous Pneumothorax

A spontaneous pneumothorax may be secondary to lesions in the lung such as the following:

Lumen (Internal Factors)

Ñ    Bacterial pneumonia

Ñ    Tuberculosis

Ñ    Pneumocystis carinii pneumonia

Mural Factors

Ñ    Bronchial asthma

Ñ    Chronic obstructive pulmonary disease

Ñ    Cystic fibrosis

Ñ    Whooping cough

Ñ    Bronchial carcinoma

Ñ    Sarcoidosis

Ñ    Congenital cysts and bullae

Ñ    Lymphangioleiomyomatosis

External Factors

Ñ    Pleural malignancy

Systemic Factors

LMS

Ñ    Rheumatoid lung disease

Ñ    Marfan’s syndrome

CNS

Ñ    Tuberose sclerosis

RAG

Ñ    Endometriosis

GIT

Ñ    Oesophageal rupture

Clinical Features

History

Ñ    History of trauma

Ñ    Sudden onset

Sex

Ñ    Usually occurs in young males

RS

Ñ    Pleuritic chest pain

Ñ    Breathlessness

Examination

IS

Ñ    Subcutaneous (surgical) emphysema

CVS

Ñ    Pericardial crunch:

A crunching or clicking sound in time with the heartbeat:

·          Hamman’s sign

RS

Ñ    Tachypnoea

Ñ    Trachea

·          Deviated to opposite side:

Large pneumothorax

Ñ    Respiratory movement:

·          Decreased

On the affected side

Ñ    Percussion note:

·          Increased resonance:

Affected side

Ñ    Breath sounds:

·          Decreased:

Affected side

Complications

CVS

Ñ    Cardiac embarrassment:

Due to mediastinal shift and decreased venous return:

·          Tension pneumothorax

Investigations

Imaging

Chest X-ray

Ñ    Anything from a thin rim of air to deflation of lung with mediastinal shift

Management

Ñ    Once the leak has sealed the air will be reabsorbed at the rate of 1.25% of the total radiographic volume of the pneumothorax per day

50% collapse = 40 days

Control

Surgery

Ñ    Aspiration

Ñ    Intercostal drainage tube

Ñ    Pleurectomy or talc pleurodesis:

·          Failure to re-expand after IC tube

·          More than 2 per year

Prognosis

Ñ    1 in 5 recur in 1^st year

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