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PNEUMOTHORAX

Pneumothorax is defined as the presence of air or gas in the pleural cavity (ie, the

potential space between the visceral and parietal pleura of the lung), which can

impair oxygenation and/or ventilation. A pneumothorax can be caused by a blunt

or penetrating chest injury, certain medical procedures, or damage from underlying

lung disease.

TYPES OF PNEUMOTHORAX

Spontaneous pneumothorax: No clinical signs or symptoms in primary

spontaneous pneumothorax until a bleb ruptures and causes pneumothorax;

typically, the result is acute onset of chest pain and shortness of breath, particularly

with secondary spontaneous pneumothoraces

Iatrogenic pneumothorax: Symptoms similar to those of spontaneous

pneumothorax, depending on patient’s age, presence of underlying lung disease,

and extent of pneumothorax

Tension pneumothorax: Hypotension, hypoxia, chest pain, dyspnoea

Catamenial pneumothorax: Women aged 30-40 years with onset of symptoms

within 48 hours of menstruation, right-sided pneumothorax, and recurrence


Pneumomediastinum: Must be differentiated from spontaneous pneumothorax;

patients may or may not have symptoms of chest pain, persistent cough, sore

throat, dysphagia, shortness of breath, or nausea/vomiting

SIGNS AND SYMPTOMS

 Respiratory findings may include the following:

- Respiratory distress (considered a universal finding) or respiratory arrest

- Tachypnea (or bradypnea as a preterminal event)

- Asymmetric lung expansion - A mediastinal and tracheal shift to the

contralateral side can occur with a large tension pneumothorax

- Distant or absent breath sounds - Unilaterally decreased or absent lung

sounds is a common finding, but decreased air entry may be absent even in

an advanced state of the disease

- Adventitious lung sounds (crackles, wheeze; an ipsilateral finding)

 Cardiovascular findings may include the following:

- Tachycardia - This is the most common finding. If the heart rate is faster

than 135 beats/min, tension pneumothorax is likely

- Pulsus paradoxus
- Hypotension - This should be considered as an inconsistently present

finding;

- Jugular venous distention - This is generally seen in tension

pneumothorax, although it may be absent if hypotension is severe

 Inspection Findings

- Unequal chest expansion.

- with a large pneumothorax, the patient will have increased respiratory

rate, increased heart rate, anxiety, bulging interspaces, and possibly

cyanosis

 Percussion Findings

- Area Will Be Hyperresonant

 Auscultation Findings

- Breath sounds decreased or absent

- Voice sounds decreased or absent

TREATMENT

 THORACOTOMY
Whereas thoracotomy is the criterion standard, it is increasingly being replaced by

VATS in the treatment of chronic or persisting pneumothoraces, for the

aforementioned reasons. Recurrence rates with thoracotomy are as low as 4%.

 PLEURODESIS

In patients with repeated pneumothoraces who are not good candidates for surgery,

Pleurodesis (or sclerotherapy) may be necessary. Pleurodesis decreases the chance

of pneumothorax recurrence. The 2 major sclerosing agents are talc and

tetracycline derivatives. Pleurodesis is painful, and the patient should be

premedicated with benzodiazepine and intrapleural lidocaine

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