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Pathology
Definition: The presence of air in the pleural cavity
Spontaneous Pneumothorax: Primary (occurring in otherwise healthy patients) or
Secondary (associated with underlying lung disease)
Open Pneumothorax: Chest wound that sucks in air causing tension pneumothorax
Tension Pneumothorax: One-way valve develops allowing air into the pleural space
Intrapleural pressure rises, venous return is impaired facilitating hypoxaemia and haemodynamic instability
Aetiology
Primary Spontaneous: smoking, taller patients
Secondary Spontaneous: COPD, asthma, pulmonary fibrosis
Trauma: blunt and penetrating chest trauma
Iatrogenic: invasive ventilation, post-chest drain, post-central line insertion
Signs
Simple Pneumothorax: Reduced chest expansion, reduced breath sounds, hyper-
resonant percussion note
Tension pneumothorax: cyanosis, severe tachypnoea, tachycardia and hypotension,
mediastinal shift away from affected side
Symptoms
Chest pain, dyspnoea
Investigations
Chest X-Ray: Aids diagnosis and sizing
CT: Useful for uncertainty or complex cases
Treatment
Spontaneous pneumothorax: Air aspiration or discharge and monitor
Tension pneumothorax: Immediate needle decompression into 2nd intercostal
space in the mid-clavicular line then chest drain insertion
Open pneumothorax: Occlusive dressing applied and taped down on three sides to
allow air to escape preventing a tension pneumothorax.
Surgical input: Used in persistent air-leak; Open thoracotomy or pleurectomy.
Chemical pleurodesis is used for those who cant tolerate surgery.
Prognosis
Reoccurrence rate in primary spontaneous 28-32% and secondary spontaneous 43%
Reoccurrence, persistent air leak, re-expansion pulmonary oedema
Key Facts
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Key References
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