Pneumothorax: types and management

1. PNEUMOTHORAX
PRESENTED BY-
Dr. MRINALINI MATHUR
MODERATED BY-
DR. PARUL TANDON (READER)

2. Pneumothorax
Definition- A collection of air or gas in the pleural cavity.

3. Classification(on the basis of
etiology)

4. Classification(on the basis of
pathology)

5. PATHOPHYSIOLOGY
Simple/ Closed Pneumothorax
-Small opening in the lung so heals rapidly.
- The mean pleural pressure is less than the
atmospheric pressure.

6. Opening/Sucking Pneumothorax
-Due to trauma to the thoracic
wall.
-Pleural pressure is equal to the
atmospheric pressure.

7. Tension Pneumothorax
-The communication formed is small
and valvular.
-It allows the entry of air in the pleural
space during inspiration but prevents
its escape during expiration.
-Therefore, the interpleural pressure
becomes more than the atmospheric
pressure.

8. Signs and Symptoms
Chest pain
Air hunger
Respiratory distress
Tachycardia
Tachypnea
Hypotension
Tracheal deviation away from the side of injury
Unilateral absence of breath sounds on auscultation
Hyper-resonance on percussion
Neck vein distention
Cyanosis(late manifestation)

9. Radiological Examination
-PA Chest: increased
translucency between the
lung and the thoracic wall.
: sharp borders of the
collapsed lungs.
: mediastinum shift to the
opposite side.
-CT scan of the chest
-Chest ultrasound

10. Management

11. BRITISH
THORACIC
SOCIETY(BTS)
GUIDELINES
2010

12. Size-
<1cm: oxygen therapy
1-2cm: needle/chest catheter
aspiration
>2cm and unstable patient:
intercostal drain(ICD)
CALCULATION OF THE SIZE OF PNEUMOTHORAX

13. OCCLUSIVE DRESSING

14. ASHERMAN CHEST SEAL

15. ASPIRATION (needle aspiration is
mostly performed as an
emergency procedure)
The underwater seal prevents the
inward movement of air. It excludes air
from re-entering the chest cavity via the
chest tube.

16. INSERTION OF INTERCOSTAL DRAIN

18. PLEURODESIS
Pleurodesis is a procedure aimed to obliterate the intrapleural space and is
performed for recurrent malignant/non-malignant effusions and recurrent
pneumothorax.
The procedure is performed in two traditional manners – mechanical and
chemical. In mechanical pleurodesis, surgeons will usually perform a video-
assisted thoracoscopic surgery (VATS), identify the parietal pleura, and rub an
abrasive material against the parietal pleura. In chemical pleurodesis, agents
like talc, minocycline, doxycycline, and silver nitrate are introduced into the
intrapleural space to generate an inflammatory response through chemical
irritation of the pleural lining.
The procedure will ultimately encompass the entire lung to achieve complete
apposition between the visceral and parietal pleural layers. Using the
aforementioned chemical or mechanical sclerosis techniques, a diffuse
inflammatory response is created promoting fibrin adhesions and the
proliferation of fibroblasts to basically lock this potential space for

19. Pleurodesis to prevent
recurrent pneumothorax

20. After-care
- Cessation of smoking
- No air travel
- No under water diving

21. THANK YOU