2. Air within the pleural cavity (i.e. between
visceral and parietal pleura)
The air enters via a defect in the visceral
pleura (e.g. ruptured bulla) or the parietal
pleura (e.g. puncture following rib fracture)
3.
4.
5.
6. Primary spotaneous pneumothorax:
- tall,thin male
- smokers
- It is due to rupture of apical sub-pleural bleb
The gradient of the pleural pressure increases
from the lung base to the apex so that alveoli
at the lung apex in tall individuals are subject
to significantly greater distending pressure
than those at the base of the lung, and this
predisposes to development of apical sub
pleural blebs
7. Secondary spontaneous pneumothorax:
- it occurs in patients with known lung disease
- rupture of emphysematous bullae
- rupture of subpleural tuberculous focus
- rupture of lung abscess especially
staphylococcal
- bronchial carcinoma
- pulmonary infarction
- bronchial asthma
8. Catamenial pneumothorax:
- rare condition
- female – 25 to 30 years
- usually on the rt side
- association with menstruation
- attacks usually occur within 48 hours before
or after the onset of menstruation
10. Iatrogenic pneumothorax:
- following diagnostic or therapeutic
interventions( e.g. secondary to transthoracic
and transbronchial biopsy, central biopsy,
thoracentesis
11. A small pneumothorax may be asymptomatic
Sudden onset chest pain
dyspnoea
12. - cyanosis, rapid thready pulse, pulsus
paradoxus and peripheral circulatory failure
-Inspection and palpation:
dyspnea
shallow breathing
shift of trachea and mediastinum
fullness of the chest
diminished chest movement
markedly diminished vocal fremitus
13. Chest x-ray
- mediastinal shift to the opposite side
- sharply defined edge of the deflated lung
- complete translucency and absence of
bronchovascular markings in the area between
the edge of the lung and chest wall
- CT scan
- Computed tomography can be useful in
particular situations
- USG
- USG is used commonly in the evaluation of
people who have sustained physical trauma
21. The communication between pleura and lung
seals off and does not reopen
Air can neither enter nor leave the pleural space.
The trapped air is slowly re-absorbed and the
lung re-expands completely in 2to4 weeks.
Closed pneumothorax manifests as trivial
breathlessness that abates over a few days
Pleural space infection is uncommon
22.
23. Asymptomatic or small pneumothorax: – no
need treatment
Symptomatic or large pneumothorax:
evacuation of the air using a syringe and
needle, three way tap and an under water seal
system
Inserting chest tube into the pleural cavity
and connecting it to water seal drainage
system or non-return valve
24. The communication between bronchus and
pleura does not seal off and remains patent,
resulting in a bronchopleural fistula
Air can freely flow through the bronchopleural
fistula, intra pleural pressure and atmospheric
pressure remain the same throughout the
respiratory cycle. this prevents the re-expansion
of the collapsed lung
Open pneumothorax usually follows rupture of
an emphysematous bulla, a small pleural bleb, a
tuberculous cavity or a lung abscess into the
pleural space
25. Pt present with breathlessness that does not
improve
26.
27. Usually requires surgical closure though a
trial with chest tube insertion with low
pressure suction
Cauterization of the opening
Video assisted thoracoscopic surgery
Open thoracotomy and direct closure of the
fistula
28. The communication between pleura and lung
persists
It acts one way valve allowing air to enter the
pleural space during inspiration, coughing,
sneezing and straining, but not allowing it to
escape
Large amounts of air gets trapped in the
pleural space and the intrapleural pressure
becomes much higher than the atmospheric
pressure
29. High intrapleural pressure results in
compression of the underlying lung, as well
as gross shift of the mediastinum to the
opposite side with consequent compression
of the lung also.
These patients present with rapidly
progressive breathlessness, central cyanosis,
rapid thready pulse and signs of peripheral
circulatory failure
30. Tension pneumothorax may develop;:
- Ventilated pt[invasive or noninvasive]
- Traumatic chest injury
- During cardiopulmonary resuscitation pt
- Lung disease – acute presentations of asthma
and copd
- Blocked,clamped or displaced chest drains
- Pt undergoing hyperbaric oxygen treatment
31.
32. Tension pneumothorax is an acute medical
emergency
Introduction of a wide bore plastic cannula,
the other end of which is attached to a long
rubber tubing, the end of which is placed
underwater seal
Introduction of an intercostal catheter
connected to a water seal drainage system
If nothing is available, simple stab on chest
wall is sufficient to release pressure
33. Common in pt with emphysematous bullae.
The episodes usually occur on the same side
It can also occur with LAM
[lymphangioleiomyomatosis]
34. Includes obliteration of the pleural space by
artificial pleurodesis-this can be
accomplished by intrapleural instillation of an
irritant like tetracycline hydrochloride or talc
powder
Pleural abrasion or parietal pleurectomy or
thoracotomy may be attempted.
