Pneumothorax

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Pneumothorax

  1. 1. Pneumothorax Dr. Hytham Nafady
  2. 2. Etiology
  3. 3. 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.
  4. 4. Subpleural bleb • Pocket of air within the visceral pleura. • < 1 cm & usually apical.
  5. 5. Secondary spontaneous pneumothorax: Due to underlying lung disease. • Cavitary lesion. • Cystic lung disease. • Emphysematous bullae. • Pneumatocele.
  6. 6. 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.
  7. 7. Pathology Pneumothorax Closed pneumothorax Open pneumothorax Tension pneumothorax
  8. 8. Closed Open pneumothorax pneumothorax Tension pneumothorax The pleural tear The pleural tear The pleural tear Is sealed is open 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
  9. 9. C.P • Dyspnea. • Pleuritic chest pain. Dyspnea is more common in 2ry spontaneous pneumothorax rather than 1ry spontaneous pneumothorax due to poor pulmonary reserve.
  10. 10. Radiological manifestations
  11. 11. Pneumothorax in erect position Pneumothorax in supine position Air in apicolateral pleural space Air in anteromedial pleural space.
  12. 12. Small pneumothorax
  13. 13. Small pneumothorax
  14. 14. Large pneumothorax
  15. 15. Large pneumothorax
  16. 16. Large pneumothorax with mediastinal shift
  17. 17. Large pneumothorax with mediastinal shift
  18. 18. Tension Pneumothorax
  19. 19. Tension pneumothorax
  20. 20. Tension pneumothorax
  21. 21. Visceral pleural line
  22. 22. DD of visceral pleural line Skin fold: • Positive mash band (optical edge enhancement). • Extend beyond the chest wall. • Lung markings extend beyond it.
  23. 23. DD of visceral pleural line Scapular edge
  24. 24. 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.
  25. 25. Giant emphysematous bulla
  26. 26. Emphysematous bulla Vs pneumothorax
  27. 27. Emphysematous bulla Vs pneumothorax
  28. 28. Signs of pneumothorax in supine position
  29. 29. Deep costophrenic sulcus
  30. 30. Sharp mediastinal contour
  31. 31. Double diaphragm sign subpulmonic pneumothorax
  32. 32. Lucent cardiophrenic sulcus
  33. 33. Large pneumothorax (without mediastinal shift)
  34. 34. CT can diagnose easily pneumothroax
  35. 35. CT can diagnose easily pneumothroax
  36. 36. U/S in pneumothorax • Classical belief lung not optimal for U/S. • Ultrasound found to be more sensitive than CXR in diagnosis of pneumothorax.
  37. 37. 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).
  38. 38. Stratosphere or bar code sign
  39. 39. Stratosphere
  40. 40. Bar code
  41. 41. Seashore
  42. 42. Recurrence of spontaneous pneumothorax • 50% on the same side. • 15% on the contralateral side. More common in • 2ry spontaneous pneumothorax.
  43. 43. 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.
  44. 44. Tension pneumothorax
  45. 45. Tension pneumothorax complicating lymphangioleimyomatosis
  46. 46. Hydropneumothorax • Due to rupture of pleural adhesions. • Bronchopleural fistula.
  47. 47. Encysted pneumothorax • Due to pleural adhesions.
  48. 48. Failure of re-expansion of the collapsed lung • Due to pleural adhesions. • Or tracheobronchial injury.
  49. 49. Re-expansion pulmonary edema • Due to rapid re-expansion of collapsed lung.
  50. 50. Quizzes
  51. 51. Emphysematous bulla
  52. 52. Emphysema & bilateral pneumothorax

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