Just the basics!

1. PNEUMOTHORAX

2. Abnormal collection of air in the
pleural space

3.  In normal people, the pressure in pleural space
is negative during the entire respiratory cycle.
 Two opposite forces result in negative pressure
in pleural space.
1.outward pull of the chest wall
2.elastic recoil of the lung
 The negative pressure will be disappeared if
any communication develops .

4.  Negative pressure eliminated>> decrease in
lung volume and lung recoil>> hypoxia
 Positive pressure >> compression of vessels
and heart>>impaired VR ,low CO, hypotension
 Reduced VC and Reduced PaO2

6.  Young males w/o overt lung disease
 Due to rupture of subpleural bulla or blebs
PREDISPOSING FACTORS
Smoking
Tall thin male
Family history
Airway inflammation
Structural abnormalities of bronchial tree

7. DUE TO UNDERLYING LUNG DISEASE
 Tb
 Acute bacteria pneumonia
 Copd
 Obstructive lung disease
 ILD
 Fibrosis
 Eosinophilic granuloma
 Sarcoidosis
 Lymphangioleiomyomato
sis..
 Primary lung carcinoma
 Complication of
chemotherpy
 Connective tissue disease
 Scleroderma
 Marfans syndrome
 Catamenial
pneumothorax
 Pulmonary infract
 Wegegner’s
granulomatosis

8. 1 . IATROGENIC:
Interventional procedures
Positive pressure ventilation
2.ACCIDENTAL/NONIATROGENIC
Blunt trauma
Penetrating trauma

9. Pneumothorax
Closed
pneumothorax
Open
pneumothorax
Tension
pneumothorax

11. SYMPTOMS SIGNS
 Small pneumothorax >>
no signs and sypmtoms
 CHEST PAIN sudden
severe pleuritic
 DYSPNEA
 Reduced expansion
 Hyperresonance to
percussion
 Diminished breath
sounds
 Tracheal deviation (
tension ptx)

12.  Medical emergency
SIGNS
 Respiratory distress
 Hypotension /Shock
 Reduced breath sounds
 Raised JVP
 Tachypnea
 tachycardia

13. 1. CHEST X RAY
2. CT SCAN
3. ULTRASOUND

14.  Visible visceral pleural edge seen as a thin,
sharp white line
 Absent lung markings
 Increased radiolucency
 Lung may be completely collapsed
 Mediastinal shift (tension ptx)

18.  For small pneumothorax that CXR can miss
 Pneumothorax vs emphysematous bulla
 Exact location

19. TREATMENT GOALS
 To promote lung expansion.
 To eliminate the pathology.
 To decrease pneumothorax recurrence.

20.  Severity of symptoms
 Size of pneumothorax on x-ray
 Presence of underlying lung disease

21.  PSP <2cm from chest wall
 No breathlessness
OBSERVATION
Resolves without
intervention
Early Follow Up

22.  SSP
 Very small < 1cm
 Less than 50 years of age
 Asymptomatic
OBSERVATION
HOSPITAL ADMISSION
HIGH FLOW OXYGEN

23.  PSP
 Large >2cm
 Symptomatic
 SSP
 moderate size without breathlessness
 Tension pneumothorax
 To convert it into open pneumothorax
 Buys time for drainage tube insertion

24.  Most definitive initial treatment of
pneumothorax
 “Safety triangle”
 Under water seal

25. INDICATIONS
 Unstable pneumothorax
 Severe dyspnea
 Large lung collapse
 Open or tension pneumothoraces
 Frequent recurrent pneumothoraces
 After unsuccessful needle aspiration

27. indicated in
RECURRENT PNEUMOTHORAX
 Permanently eliminates the pleural space
 Attaches lung to the chest wall
 SURGIGAL :Pleurectomy of outer layer and
abrasion of inner layer
 CHEMICAL: Using Sclerosing agents