Chest X ray :sharply defined edge of deflated lung with
Chest X ray will also show any extent of any mediastinal
displacement and give information regarding presence or
absence of pleural fluid
Care must be taken in order to differentiate between
pneumothorax and emphysematous bullae to avoid a
misdirected attempts of aspiration.
if any doubts GO for CT scan : CT scan help-s to differentiate
between bullae and pleural air.
MEDIASTINAL SHIFT/TENSION PNEUMOTHORAX
CHRONIC LUNG DISEASE
GREATER THAN 50 YEARS OF AGE
PERCUTANEOUS NEEDLE ASPIRATION
GREATER THAN 2.5 L AIR ASPIRATED OR
OBSERVE PATIENT FOR
6 HOURS OUTPATIENT
Primary pneumothorax : when lung edge is less than 2 cm from
chest wall and patient is not breathless normally resolves
Young patients : we do PNA of air rather than ICD tube.
Patient with underlying Chronic lung disease: small secondary
pneumothorax may cause respiratory failure. THIS type of
patients require ICD
In Tension Pneumothorax :immediate decompression is requires
prior to insertion of intercostal drain.
Aspiration : is done in 2nd intercostal space anteriorly in MCL
using 16 F cannula.
ASPIRATION OF AIR
When needed ICD is done in 4,5,6 IC space in MAL following
Blunt dissection to pleura.
Tube should be connected to an underwater seal
Should be secured firmly on chest wall
Drain should be removed 24 hr. after lung has fully re inflated
and bubbling stopped.
Continued bubbling after 5-6 days is an indication for surgery.
If bubbling in under water bottle is stops prior to full re
inflation the tube is either blocked, kinked or displaced.
*ALL patients should receive supplemental oxygen as this
accelerates the rate at which air is reabsorbed from pleura.
Recurrent pneumothorax: patient is advised to stop
smoking as it is a RISK factor for pneumothorax.
Flying and diving are RISK factors for recurrent
Surgical pleurodesis is recommended for all patients
following the 1st episode of secondary pneumothorax
Pleurodesis is achieved by parietal pleurectomy at
thoracotomy or thoracoscopy