Pneumothorax

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1. Pneumothorax By: M. Suleiman Aljajeh 1 2014-2015

2. Contents: Definition Types Clinical features Risk factors Diagnosis Treatment Complications 2

3. Definition: “ Pneumothorax :  is an abnormal collection of air or gas in the pleural space separating the lung from the chest wall which may interfere with normal breathing, causing the lungs to collapse.” 3

4. Types : Spontaneous pneumothorax: Primary: It occurs in young healthy individuals without underlying lung disease . It is due to rupture of apical sub-pleural bleb . Secondary:  occurs in the presence of pre-existing lung  pathology. Ex : Cystic lung disease ,COPD, LUNG CANCER & T.B 4

5. Cont. Traumatic pneumothorax: Open: Chest wall is damaged by any wound --outside air enters pleural space and causes lungs to collapse. Closed: here chest wall is punctured or air leaks from a ruptured bronchus Iatrogenic : Ex. Postoperative Mechanical ventilation , Thoracocentesis & Central venous cannulation . 5

6. Is it type or complication ?! 3. Tension pneumothorax : It is life threatening condition…The pleural pressure is more than the atmospheric pressure. Radiological manifestations of large pneumothorax : Mediastinal shift, Flattening of the hemidiaphragm & Lung collapse. Associated with clinical manifestations of circulatory collapse (tachycardia, hypotension & sweating). It is more common with Positive pressure ventilation & Traumatic pneumothorax. 6 ER

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8. The pleural cavity pressure is < the atmospheric pressure The pleural cavity pressure is = the atmospheric pressure The pleural cavity pressure is > the atmospheric pressure 8

9. Clinical features : Predominant symptom is acute pleuritic chest pain Dyspnoea results form pulmonary compression On  physical examination : Breath sounds may be diminished on the affected side Percussion of the chest may be perceived as hyperresonant . Physical signs include Tachypnoea Increased resonance Absent breath sounds  Hypoxemia  Cyanosis   Hypercapnia   9

10. Real Pneumothorax | Percussion | Hyperresonance 10

11. Don’t forget Lutfen !! 11

12. Risk factors : Sex : men are far more likely to have a pneumothorax than are women . Smoking . Age. The type of pneumothorax caused by ruptured air blisters is most likely to occur in people between 20 and 40 years old, especially if the person is a very tall and underweight man. Genetics . Lung disease. Having an underlying lung disease — especially chronic obstructive pulmonary disease (COPD) — makes a collapsed lung more likely. Mechanical ventilation . A history of pneumothorax . 12

13. Diagnosis – Chest Xray The characteristics of pneumothorax Pleural line No lung markings in pneumothorax 13

14. CT Scanning A further use of CT is in the identification of underlying lung lesions 14

15. Treatment : Goals : To promote lung expansion. To eliminate the pathogenesis. To decrease pneumothorax recurrence. Treatment options : Simple aspiration Intercostal tube drainage Guidewire tube thoracostomy Surgical treatment 15

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19. Complications of pneumothorax Recurrence of spontaneous pneumothorax Tension pneumothorax Hydropneumothorax Encysted pneumothorax Failure of expansion of the collapsed lung Re-expansion pulmonary edema Broncho-pleural fistula Pneumomediastinum 19

20. Hint points : 20

21. References : 21 1. Kumar and Clark Clinical Medicine 2. USMLE Step 2 CK 3. Harrison's Principles of Internal Medicine

22. Three Kings - Tension Pneumothorax 22

23. THNXS 23