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Pneumothorax Pneumothorax Presentation Transcript

  • Pneumothorax Dr. Hytham Nafady
  • Etiology
  • Primary spontaneous pneumothorax • It occurs in young healthy individuals without underlying lung disease. • It is due to rupture of apical sub-pleural bleb. Predisposing factors: • Smoking. • Tall, thin male. Recurrence: • 50% on the same side. • 10% on the opposite side.
  • Subpleural bleb • Pocket of air within the visceral pleura. • < 1 cm & usually apical.
  • Secondary spontaneous pneumothorax: Due to underlying lung disease. • Cavitary lesion. • Cystic lung disease. • Emphysematous bullae. • Pneumatocele.
  • Traumatic pneumothorax Accidental trauma: • Blunt trauma: with fracture ribs. • Penetrating trauma: stab wound or gun shot injury. Iatrogenic trauma: • Positive pressure ventilation: Alveolar rupture  interstitial emphysema  pneumothorax. • Interventional procedures: Biopsy, thoraco-centesis, CVP line.
  • Pathology Pneumothorax Closed pneumothorax Open pneumothorax Tension pneumothorax
  • Closed Open pneumothorax pneumothorax Tension pneumothorax The pleural tear The pleural tear The pleural tear Is sealed is open act as a ball & valve mechanism The pleural cavity pressure is < the atmospheric pressure The pleural cavity pressure is = the atmospheric pressure The pleural cavity pressure is > the atmospheric pressure
  • C.P • Dyspnea. • Pleuritic chest pain. Dyspnea is more common in 2ry spontaneous pneumothorax rather than 1ry spontaneous pneumothorax due to poor pulmonary reserve.
  • Radiological manifestations
  • Pneumothorax in erect position Pneumothorax in supine position Air in apicolateral pleural space Air in anteromedial pleural space.
  • Small pneumothorax
  • Small pneumothorax
  • Large pneumothorax
  • Large pneumothorax
  • Large pneumothorax with mediastinal shift
  • Large pneumothorax with mediastinal shift
  • Tension Pneumothorax
  • Tension pneumothorax
  • Tension pneumothorax
  • Visceral pleural line
  • DD of visceral pleural line Skin fold: • Positive mash band (optical edge enhancement). • Extend beyond the chest wall. • Lung markings extend beyond it.
  • DD of visceral pleural line Scapular edge
  • DD of apical radiolucency Emphysematous bulla: • Rounded (while pneumothorax is crescentic & tapers toward the lung base). • Double wall sign on CT is consistent with ruptured bulla causing pneumothorax.
  • Giant emphysematous bulla
  • Emphysematous bulla Vs pneumothorax
  • Emphysematous bulla Vs pneumothorax
  • Signs of pneumothorax in supine position
  • Deep costophrenic sulcus
  • Sharp mediastinal contour
  • Double diaphragm sign subpulmonic pneumothorax
  • Lucent cardiophrenic sulcus
  • Large pneumothorax (without mediastinal shift)
  • CT can diagnose easily pneumothroax
  • CT can diagnose easily pneumothroax
  • U/S in pneumothorax • Classical belief lung not optimal for U/S. • Ultrasound found to be more sensitive than CXR in diagnosis of pneumothorax.
  • U/S signs of pneumothorax • • • • Loss of lung sliding. Loss of comet tails. loss of seashore sign (M mode). Stratosphere sign or bar code sign(M mode).
  • Stratosphere or bar code sign
  • Stratosphere
  • Bar code
  • Seashore
  • Recurrence of spontaneous pneumothorax • 50% on the same side. • 15% on the contralateral side. More common in • 2ry spontaneous pneumothorax.
  • Tension pneumothorax • It is life threatening condition. • The pleural pressure is more than the atmospheric pressure. Radiological manifestations of large pneumothorax • Mediastinal shift, • Flattening of the hemidiaphragm & • Lung collapse. Associated with clinical manifestations of circulatory collapse (tachycardia, hypotension & sweating). It is more common with • Positive pressure ventilation & • Traumatic pneumothorax.
  • Tension pneumothorax
  • Tension pneumothorax complicating lymphangioleimyomatosis
  • Hydropneumothorax • Due to rupture of pleural adhesions. • Bronchopleural fistula.
  • Encysted pneumothorax • Due to pleural adhesions.
  • Failure of re-expansion of the collapsed lung • Due to pleural adhesions. • Or tracheobronchial injury.
  • Re-expansion pulmonary edema • Due to rapid re-expansion of collapsed lung.
  • Quizzes
  • Emphysematous bulla
  • Emphysema & bilateral pneumothorax