Pneumothorax
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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management
Definition
Pneumothorax is a medical condition where there is an accumulation or build up of air within the pleural space of the lungs.
Aetiology
Spontaneous: common in tall, thin individuals (mainly male) around the age of 10 - 30 years old.
Underlying lung disease: asthma, cystic fibrosis, industrial lung disease and COPD.
Following trauma to the chest.
Pathophysiology
There is an opening in the pleural cavity > air enters from the outside.
Accumulation of air in the pleural cavity > increased air pressure > lung collapse.
Reduced gas exchange and oxygenation > reduced cardiac output > hypotension.
Risk factors
Trauma to chest.
Lung diseases: COPD, asthma, cystic fibrosis and other lung diseases.
Smoking.
Genetics: e.g. Marfan syndrome.
Age: common in younger individuals.
Gender: male are at higher risk of developing pneumothorax.
Sign and symptoms
Acute onset of chest pain on the side of the pneumothorax.
SOB.
O/E: deviated trachea, hyperresonance, reduced breath sound on the side of the pneumothorax, reduced tactile fremitus.
Diagnosis and investigations
Chest X-ray.
CT scan.
ABG: this will show hypoxemia.
Management
Hospital admission.
Tension pneumothorax: this is a medical emergency. A large bore needle, should be inserted into the second intercostal space, midclavicular line.
Spontaneous pneumothorax: if < 2 cm the pneumothorax should self resolve. Oxygen therapy and monitoring.
Chest drainage or aspiration might be considered if pneumothorax > 2cm.
Surgery may be considered if chest drainage or aspiration fails to resolve the pneumothorax.
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