Pneumothorax is the accumulation of air in the pleural space between the lungs and chest wall. It can be primary, occurring without underlying lung disease, or secondary, caused by conditions like COPD or trauma. Symptoms include shortness of breath and chest pain. Diagnosis is made through chest x-ray or ultrasound showing a clear area without lung markings. Treatment depends on severity but may include tube insertion to drain air for a spontaneous pneumothorax or surgery for recurring or tension pneumothorax where air pressure builds.

1. PNEUMOTHORAX
Dr Taniya Pruthi

2. INTRODUCTION-
• It is the accumulation of the air in pleural
space between parietal and visceral pleura
• Parietal pleura lines the rib cage
• Visceral pleura lines the lung
Dr Taniya Pruthi

3. mechanics
• The pressure in the pleural space is sub
atmospheric but more than a very small
amount of air causes positive pressure and
collapse of the underlying lung.
Dr Taniya Pruthi

4. TYPES
• Primary spontaneous pneumothorax-with no
precipitating event or any underlying lung
disease.
• Secondary pneumothorax –with underlying
lung disease or following trauma.
• Tension penumothorax- positive pressure in
pleural space throughout the respiratory
cycle.
Dr Taniya Pruthi

5. Other classifications-
• It could be localized(confined by adhesions) or
generalized.
• It could be open,close,valvular.
o Open-communication with atmospheric air
remains patent
o Closed-communication with atmospheric air is
sealed off.
o Valvular-communication with outside air is
valvular that only allows air entry.
Dr Taniya Pruthi

6. Primary Pneumothorax
• More common in young, tall and thin men.
• Occurs as a result of rupture of pre-existing
apical blebs.
• a/w marfan syndrome
Bullae
Dr Taniya Pruthi

7. Secondary Pneumothorax
• a/w underlying lung diseases like
Emphysema
Cystic fibrosis
Granulomatous inflammation
Sarcoidosis
• Trauma which could be blunt or penetrating
• Catamenial pneumothorax – diaphragmatic
endometriosis get ruptured at the time of
mensturation causing pneumothorax.
Copd lung
Dr Taniya Pruthi

8. Tension Pneumothorax
• It is seen during the mechanical ventilation
• Due to positive pressure in the pleural space
the ventilation is severely compromised and
venous return is decreased leading to
decreased cardiac output.
• Cause of death
Marked hypoxemia
Inadequate cardiac
ouput
Dr Taniya Pruthi

9. Symptoms and examination
• Acute shortness of breath
• Sharp chest pain
On general physical examination-
A. Tachycardia
B. Tachypnea
C. Tracheal shift towards the uninvolved side
on systemic examination-
I. Hyper resonance to percussion
II. Decreased tactile fremitus
III. Decreased breath sound
IV. Pleural friction rub
Dr Taniya Pruthi

10. • Important points seen with pneumothorax-
Cyanosis is seen with emphysematous and
tension pneumothorax
If secondary infection occurs in open variety
patient can have fever,leucocytosis,and raised esr.
Coin test-place the coin in front just below the
mid clavicle and strike it with other coin as
assisted by other person. keep the stethoscope at
the same level on the back and if metallic high
pitched sounds are heard , the above test is
positive .elicited in large bullae
Dr Taniya Pruthi

11. • Scratch sign test-place the stethoscope in the
middle of sternum and scratch the chest wall
one by one and the site with pneumothorax will
produce louder sound.
• Succussion splash seen in hydropneumothorax
• method -First percuss the upper
Limit of dullness then place
Stethoscope just above it
Shake the patient and splashing
sound with heard.
air
fluid
Dr Taniya Pruthi

12. Images showing the
mediastinal shift due to air in
the pleural cavity
Dr Taniya Pruthi

13. Diagnosis
• History and physical examination
• Upright chest x ray-
1. Clear zone devoid of lung markings will be
seen
2. If massive then it can compress the lung
visualized as a globular dense mass at the
hilum.
• Ultrasound of thorax can also be done
Dr Taniya Pruthi

14. Collapsed lung
Pneumothorax as
the clear zone is
devoid of lung
markings
Dr Taniya Pruthi

15. Differential diagnosis
• Myocardial infarction- do ecg and chest x ray
• Pulmonary embolism
• Perforated peptic ulcer
Dr Taniya Pruthi

16. Management
• spontaneous pneumothorax-
• If small and closed (covering less than 20% of
hemithorax)- no specific treatment
required,air will get absorbed.
• If it covers more than 20% of hemithorax -
aspiration is required termed as tube
thoracostomy.
Dr Taniya Pruthi

17. • Secondary pneumothorax-
1. Tube thoracostomy or thoracotomy with
stapling of bleb
2. If cannot be done then pleurodesis
• Traumatic pneumothorax-
If only has air in the
cavity do tube
thoracostomy
If has air and blood both then
for air insert the tube from the
upper thorax and for the blood
drainage in the lower thorax
Dr Taniya Pruthi

18. • Tension pneumothorax- medical emergency
1. Large bore needle has to be inserted into the
second anterior intercostal space
2. Leave it there until tube thoracostomy is
inserted.
• Recurrence can be prevented- by adding
sclerosing agent
• Chronic pneumothorax- if persist more than
three months.
• Supportive therapy-oxygen thearpy and
analgesics
Dr Taniya Pruthi

19. Follow up
• Every three months patient had to be followed
up for a year to look for any complications or
recurrences
• Complication and treatment
complication treatment
haemothorax Thoracotomy and clot evacuation
infection antibiotic
Atelactasis physiotherapy
Dr Taniya Pruthi

20. Thank you!!!! Enjoy your
quarantine