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Pneumothorax (Epidemiology (Often patients are thin and tall, Caused by a…
Pneumothorax
Epidemiology
Often patients are thin and tall
Caused by a rupture of a pleural bleb/sub-plural bulla, usually apical thought to be due to congenital defects in the connective tissue of the alveolar walls
Generally much more common in males
Both lungs are affected with equal frequency i.e. can occur in any lung right or left equally
Spontaneous pneumothorax is most common in young males
In patients over 40 years of age the usual cause in underlying COPD
Occurs spontaneously or secondary to chest trauma
Other/rarer causes include: bronchial asthma, carcinoma, breakdown of a lung abscess leading to bronchopleural fistula, severe pulmonary fibrosis with cyst formation, TB, pneumonia, cystic fibrosis, trauma, iatrogenic
Treatment
Observation
Oxygen for hypoxia
Needle aspiration to remove excess air
For tension pneumothorax do needle aspiration then chest drain - NEEDLE ASPIRATION FIRST
Surgery for persistent pneumothorax
Pneumothorax due to trauma, haemothorax or mechanical ventilation requires chest drain
Smoking cessation reduces recurrence of pneumothorax
Clinical Presentation
As the pneumothorax enlarges the patients becomes more breathless and may develop pallor and tachycardia
Patients with asthma or COPD may present with a sudden deterioration
May be sudden onset of dyspnoea and/or unilateral pleuritic chest pain
Mechanically ventilated pattens may present with hypoxia or an increase in ventilation pressures
There may be no symptoms, especially in patients who are fit and young with a small pneumothorax
There will be reduced expansion, hyper-resonance to percussion and diminished breath sounds of the affected lung
Risk Factors
Smoking increases risk
Age - pneumothorax due to pleural bleb rupture is most likely to occur between 20-40 years, especially if person is very tall and underweight
Being male
On mechanical ventilation
Pathophysiology
If the communication between the airways and the pleural space remains open then a bronchopleural fistula results
Once the communication between the lung and the pleural space is closed, air will be reabsorbed slowly
Normally, the pressure in the pleural space is negative but this is lost once there is communication with atmospheric pressure
Key Facts
Means air in the pleural space
Leads to partial or complete collapse of the lung
Diagnosis
CXR
DO NOT REQUEST IN TENSION PNEUMOTHORAX - WASTES TIME
Look for area devoid of lung marking, peripheral to the edge of the collapsed lung
ABGs
In dyspneic patients check for hypoxia
Differential Diagnosis
Pleural effusion, chest pain, pulmonary embolism