This document discusses pneumothorax, beginning with the causes and types. Primary spontaneous pneumothorax is usually caused by a ruptured bleb and occurs more often in young, thin males who smoke. Secondary spontaneous pneumothorax has an underlying lung disease like emphysema. Traumatic pneumothorax results from blunt or penetrating chest trauma or medical procedures. Imaging findings and complications are also described, including recurrent pneumothorax, tension pneumothorax, and re-expansion pulmonary edema. Ultrasound is a sensitive test for pneumothorax diagnosis.

1. Pneumothorax
Dr. Hytham Nafady

2. Etiology

9. 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.

10. Subpleural bleb
• Pocket of air within the visceral pleura.
• < 1 cm & usually apical.

11. Secondary spontaneous
pneumothorax:
Due to underlying lung disease.
• Cavitary lesion.
• Cystic lung disease.
• Emphysematous bullae.
• Pneumatocele.

12. 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.

13. Pathology
Pneumothorax
Closed
pneumothorax
Open
pneumothorax
Tension
pneumothorax

14. Closed
pneumothorax
Open
pneumothorax
Tension
pneumothorax
The pleural tear
Is sealed
The pleural tear
is open
The pleural tear
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

15. C.P
Dyspnea is more common in 2ry spontaneous pneumothorax rather than
1ry spontaneous pneumothorax due to poor pulmonary reserve.
• Dyspnea.
• Pleuritic chest pain.

16. Radiological manifestations

17. Pneumothorax
in erect position
Pneumothorax
in supine position
Air in apicolateral pleural
space
Air in anteromedial pleural
space.

19. Small pneumothorax

20. Small pneumothorax

21. Large pneumothorax

22. Large pneumothorax

23. Large pneumothorax with
mediastinal shift

24. Large pneumothorax with
mediastinal shift

25. Tension Pneumothorax

26. Tension pneumothorax

27. Tension pneumothorax

28. Visceral pleural line

29. DD of visceral pleural line
Skin fold:
• Positive mash band (optical edge enhancement).
• Extend beyond the chest wall.
• Lung markings extend beyond it.

30. DD of visceral pleural line
Scapular edge

31. 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.

32. Giant emphysematous bulla

33. Emphysematous bulla Vs
pneumothorax

34. Emphysematous bulla Vs
pneumothorax

35. Signs of pneumothorax in
supine position

36. Deep costophrenic sulcus

37. Sharp mediastinal contour

38. Double diaphragm sign
subpulmonic pneumothorax

39. Lucent cardiophrenic sulcus

40. Large pneumothorax
(without mediastinal shift)

41. CT can diagnose easily
pneumothroax

42. CT can diagnose easily
pneumothroax

43. U/S in pneumothorax
• Classical belief lung not optimal for U/S.
• Ultrasound found to be more sensitive
than CXR in diagnosis of pneumothorax.

44. 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).

58. Stratosphere or bar code sign

60. Stratosphere

61. Bar code

62. Seashore

66. Recurrence of spontaneous
pneumothorax
• 50% on the same side.
• 15% on the contralateral side.
More common in
• 2ry spontaneous pneumothorax.

67. 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.

68. Tension pneumothorax

69. Tension pneumothorax complicating
lymphangioleimyomatosis

70. Hydropneumothorax
• Due to rupture of pleural adhesions.
• Bronchopleural fistula.

71. Encysted pneumothorax
• Due to pleural adhesions.

72. Failure of re-expansion of the
collapsed lung
• Due to pleural adhesions.
• Or tracheobronchial injury.

73. Re-expansion pulmonary edema
• Due to rapid re-expansion of collapsed lung.

74. Quizzes

77. Emphysematous bulla

80. Emphysema & bilateral pneumothorax