1. CASE
PRESENTATION
PNEUMOTHORAX

2. CASE HISTORY
A 5 days old baby girl with chief
complaints of
- Shortness of breath
- Grunting
- Poor feeding
No hx of trauma or fall

3.  EXAMINATION:
- Reduced chest movements
- Diminished breath sounds on
left side.
-Tachycardia
- Cynosis

5. Follow up x-ray

7. PNEUMOTHORAX
 Collection of air in the pleural space,
resulting in partial or complete collapse of
the affected lung.

8. Types of Pnuemothorax
 Open Pneumothorax: Air move freely in and
out of the pleural space during respiration.
 Closed Pneumothorax: no movement of air .
 Valvular Pneumothorax: Air enters the pleural
space on inspiration but does not leave on
expiration. As a result intraplueral pressure
increases and tension pnuemothorax develops.

9. Open Pneumothorax

10. Tension Pneumothorax

11. Causes of Pneumothorax
 Spontaneous pneumothorax
a. Primary
b. Secondary
 Traumatic pneumothorax
a. Iatrogenic
b. Non iatrogenic

12. SPONTANEOUS PNEUMOTHORAX
Occur without an obvious precipitating
event.
PRIMARY- if patient does not have
known lung disease and history of trauma.
Caused by a rupture of sub pleural bleb or
area of disruption in the pleura.
Common in young men and smokers.

13. b. SECONDRY- Occurs as a complication of
underlying lung disease.
 Diseases of the airways( COPD , Asthma )
 Pulmonary infections (T.B, Pnuemonia)
 Interstitial lung diseases (sarcoidosis)
 Lung cancer, sarcomas
 Connective tissue diseases.

14. TRAUMATIC
PNEUMOTHORAX
a. IATROGENIC:
 Pleural aspiration or biopsy
 Broncoscopy
 Tracheostomy
 Lung or liver biopsy
 Mechanical ventilation

15. b. NON IATROGENIC:
 Penetrating chest trauma
 Closed chest trauma (rupture of bronchus
in RTA)
 Rib fractures.

16. Symptoms:
 Asymptomatic
 Chest pain
 Dyspnea
 Tachypnea
 Palpitations
 Cynosis
CLINICAL FEATURES

17. Signs:
 Reduced chest movements
 Hyper resonant lung on percussion
 Diminished breath sounds
 Tachycardia
 Displaced apex beat
 In severe cases: Raised JVP
Confusion
Shock

18. RADIOLOGICAL IMAGING

19. Chest X-ray
 The first line imaging modality to diagnose
pneumothorax, which may also
demonstrate complications and relevant
underlying lung pathology.

20. Signs indicating pneumothorax on an erect
chest radiograph include:
- Visceral pleural line separated from chest
wall by a transradiant area devoid of blood
vessels.
- Deep costophrenic sulcus laterally.
- Diaphragm depression.
- Mediastinal shift .

25.  When erect inspiratory radiograph is
indeterminate, an expiratory radiograph
may help in making the diagnosis.

27. Deep Sulcus sign

28. Computed tomography
Occasionally it is difficult to differentiate
pneumothorax from other pulmonary lesions or
overlying transradiancies like cysts, bullae,
pneumatocoeles, pneumomediastinum and local
emphysema. CT can confidently make the
diagnosis in these cases if required.

32. Complications of Pneumothorax
 Haemopneumothorax :
A common complication of traumatic
pneumothorax.
Blood may clot in the pleural space,
producing a mass which can mimic a
plueral tumor.ss

33.  Pyopneumothorax :
most commonly seen following
necrotizing pnuemonia or oesophageal
perforation.

35.  Cardiovascular collapse:
In tension pneumothorax
displacement of mediastinal structures
contralaterally causes kinking of superior
and inferior vena cava. Venous return to
the heart severely compromised resulting
in low cardiac output and SHOCK.

36.  Adhesions :
Common in patients having recurrent
episodes of pneumothorax.
They limit collapse but at the same time
account for continued air leakage from the
lung surface , and if they tear they may
bleed.

38.  Re-expansion oedema:
It is sometimes seen following the rapid
therapeutic re-expansion of a lung that has
been markedly collapsed for several days.
It is characterized by the development of
extensive consolidation through out the
ipsilateral lung, which usually resolves
within a day or two.

40. Differential Diagnosis

45. TREATMENT OPTIONS
 Small pneumothoraces typically resolves by
themselves and require no treatment
especially in those with no underlying
disease.
 In large pneumothoraces or when there are
sever symptoms ;
Air aspiration with syringe
or
one way chest tube insertion is done to allow
air to escape.

47.  Occasionally various surgical measures
involving Pleurodesis (sticking the lung to
the chest wall) are required esp when tube
drainage is un successful or pt has
repeated episodes.

48. THANKS