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Pneumothorax

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By: M. Suleiman Aljajeh
1
2014-2015
1. Definition
2. Types
3. Clinical features
4. Risk factors
5. Diagnosis
6. Treatment
7. Complications
2
 “Pneumothorax : is an abnormal
collection of air or gas in the pleural
space separating the lung from
the chest wall which may interfere with
normal breathing, causing the lungs to
collapse.”
3
1. Spontaneous pneumothorax:
 Primary: It occurs in young healthy
individuals without underlying lung
disease. It is due to rupture of apical sub-
pleural bleb.
 Secondary: occurs in the presence of pre-
existing lung pathology. Ex : Cystic lung
disease ,COPD, LUNG CANCER &T.B
4
2. Traumatic pneumothorax:
 Open: Chest wall is damaged by any wound -
-outside air enters pleural space and causes
lungs to collapse.
 Closed: here chest wall is punctured or air
leaks from a ruptured bronchus
 Iatrogenic : Ex. Postoperative Mechanical
ventilation ,Thoracocentesis & Central
venous cannulation .
5
3. 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. 6
ER

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Pneumothorax

  • 1. By: M. Suleiman Aljajeh 1 2014-2015
  • 2. 1. Definition 2. Types 3. Clinical features 4. Risk factors 5. Diagnosis 6. Treatment 7. Complications 2
  • 3.  “Pneumothorax : is an abnormal collection of air or gas in the pleural space separating the lung from the chest wall which may interfere with normal breathing, causing the lungs to collapse.” 3
  • 4. 1. Spontaneous pneumothorax:  Primary: It occurs in young healthy individuals without underlying lung disease. It is due to rupture of apical sub- pleural bleb.  Secondary: occurs in the presence of pre- existing lung pathology. Ex : Cystic lung disease ,COPD, LUNG CANCER &T.B 4
  • 5. 2. Traumatic pneumothorax:  Open: Chest wall is damaged by any wound - -outside air enters pleural space and causes lungs to collapse.  Closed: here chest wall is punctured or air leaks from a ruptured bronchus  Iatrogenic : Ex. Postoperative Mechanical ventilation ,Thoracocentesis & Central venous cannulation . 5
  • 6. 3. 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. 6 ER
  • 7. 7
  • 8. The pleural cavity pressure is < the atmospheric pressure The pleural cavity pressure is = the atmospheric pressure The pleural cavity pressure is > the atmospheric pressure 8
  • 9.  Predominant symptom is acute pleuritic chest pain  Dyspnoea results form pulmonary compression  On physical examination:  Breath sounds may be diminished on the affected side  Percussion of the chest may be perceived as hyperresonant.  Physical signs include  Tachypnoea  Increased resonance  Absent breath sounds  Hypoxemia  Cyanosis  Hypercapnia 9
  • 10. 10
  • 11. 11
  • 12.  Sex : men are far more likely to have a pneumothorax than are women.  Smoking.  Age.The type of pneumothorax caused by ruptured air blisters is most likely to occur in people between 20 and 40 years old, especially if the person is a very tall and underweight man.  Genetics.  Lung disease. Having an underlying lung disease — especially chronic obstructive pulmonary disease (COPD) — makes a collapsed lung more likely.  Mechanical ventilation.  A history of pneumothorax. 12
  • 13.  The characteristics of pneumothorax  Pleural line  No lung markings in pneumothorax 13
  • 14.  A further use of CT is in the identification of underlying lung lesions 14
  • 15. Goals : To promote lung expansion. To eliminate the pathogenesis. To decrease pneumothorax recurrence.  Treatment options :  Simple aspiration  Intercostal tube drainage  Guidewire tube thoracostomy  Surgical treatment 15
  • 16. 16
  • 17. 17
  • 18. 18
  • 19. Complications of pneumothorax Recurrence of spontaneous pneumothorax Tension pneumothorax Hydropneumothorax Encysted pneumothorax Failure of expansion of the collapsed lung Re-expansion pulmonary edema Broncho-pleural fistula Pneumomediastinum 19
  • 20. 20
  • 21. 21 1. Kumar and Clark Clinical Medicine 2. USMLE Step 2 CK 3. Harrison's Principles of Internal Medicine
  • 22. 22
  • 23. 23