Presentaion on pneumotharax.pptx xray, ct scan

Interesting presentation on pneumotorax. Good for lecturing medic students.

1. Pneumothorax refers to the presence of gas (often air) in the  pleural space 3 types Tension pneumothora x Simple pneumothorax  (if no tension is present ). occult pneumothorax  refers to one missed on initial imaging, usually a  supine /semierect AP chest radiograph 1

2. Pneumothorax clinic severe dyspnea with tachycardia hypotension. tension pneumothorax , presentation may include distended neck veins and tracheal deviation, cardiac arrest, and death in the most severe cases. primary spontaneous : pleuritic chest pain , dyspnea mild or moderate secondary spontaneous: pleuritic chest pain often absent, dyspnea usually severe 2

3. Pneumothorax type/SPONTANEOUS Primary spontaneous occurs in a patient with no known underlying lung disease .  Tall and thin habitus are more likely to develop a primary spontaneous pneumothorax. familial component, and there are well-known associations? Ex: Marfan syndrome,….. homocystinuria 4

4. Secondary spontaneous When the underlying lung is abnormal , a pneumothorax is referred to as secondary spontaneous cystic lung disease bullae ,  blebs , emphysema ,  asthma , cystic fibrosis parenchymal necrosis A s in lung abscess , necrotic pneumonia, pulmonary infarction O ther catamenial pneumothorax  2,4: recurrent spontaneous pneumothorax during menstruation, associated with   endometriosis  of pleura 5

5. Iatrogenic : Percutaneous biopsy Barotrauma (e.g. divers), ventilator Radiofrequency (RF) ablation of lung mass Endoscopic perforation of the esophagus central venous catheter  insertion,  nasogastric tube placement 6

6. T rauma : pulmonary laceration tracheobronchial rupture acupuncture Oesophageal rupture 7

7. Radiographic features Flattened hemidiaphragm/ the most reliable sign. Increased retrosternal airspace. Increased and usually irregular radiolucency of the lung/ Increase anteroposterior diameter of the chest Widely spaced ribs external bowing. A paucity of blood vessels which are often distorted. Pruning of peripheral vessels An increased caliber of central arteries. 8

8. Left Primary Spontaneous Pneumothorax . CXR ( A) at deep inspiration and (B) at deep expiration. The left lung has partially collapsed and an area of extreme low density without vascular markings becomes visible. The pneumothorax is accentuated on the chest radiograph at suspended deep expiration (B). 9

9. Skin Folds Mimicking a Right Pneumothorax (arrows) . The laterally located blood vessels, the wide margin of the lines, and the orientation of the lines that is inconsistent with the edge of a slightly collapsed lung help to differentiate them from a real pneumothorax 10

10. Supine Pneumothorax . Portable chest radiograph after development of a pneumothorax in a patient with a bilateral pneumonia. There is an increase of transradiancy at the left lung base and the costophrenic sulcus laterally is more pronounced (‘deep sulcus sign’). 11

11. ‘ Comet Tails ’ of Pleural Ultrasound. Vertical echogenic bands caused by reverberation artefacts (horizontal arrows) . The echogenic ‘pleural stripe’ represents normal pleura (vertical arrows) . The pleural stripe tends to shimmer at the pleural surface and is described as ‘lung sliding’. These features disappear in a pneumothorax

12. CT T he most sensitive. widespread subcutaneous emphysema or consolidation, when a pneumothorax on chest radiography may not be readily apparent. D etects ancillary relevant findings (e.g. lung contusions in the context of trauma). CT can help guide chest drain insertion, particularly in the context of severe emphysema when bullous disease is to be avoided. Furthermore, a significant proportion of pneumothoraces post-lung biopsy are not detectable on chest radiography (25%–40%)

13. Complications Haemopneumothorax of traumatic pneumothorax Tension Pneumothorax when intrapleural pressure becomes positive relative to atmospheric pressure for a significant part of the respiratory cycle. CXR: moderate or gross contralateral mediastinal shift and ipsilateral diaphragm depression. Pyopneumothorax : following necrotizing pneumonia or oesophageal perforation. Adhesions : straight band shadows extending from the lung margin to the chest wall.

14. Reexpansion Oedema: following the rapid therapeutic reexpansion of a lung that has been markedly collapsed for several days or more. W ithin hours of drainage, may progress for a day or two and clears within a week.

15. References Andreas Adam, Adrian K. Dixon, 2021 Grainger and allison’s diagnostic radiology, Elsevier Radiology essentials Radioloy masterclass Radiopedia

16. THANK YOU