This document provides an overview of pneumothorax, including its definition, classification, mechanisms, clinical presentation, diagnosis, and management. Pneumothorax is defined as the presence of air in the pleural space, and can be spontaneous, traumatic, or iatrogenic. It presents with symptoms like dyspnea and chest pain. Diagnosis is typically made through chest x-ray or CT scan. Management depends on the type and severity, and may include oxygen therapy, needle aspiration, chest tube drainage, or surgery like pleurodesis for recurrent cases.

1. Short Note:
Pneumothorax
Presented by:
Dr. Dharmendra Joshi
1

2. Introduction:
 Laennec described the clinical picture of
Pneumothorax in 1819.
 The modern description of primary
spontaneous pneumothorax occurring in
otherwise healthy people was provided
by Kjaergard in 1932.
 Primary pneumothorax remains a
significant global problem.
 Incidence is 18-28/100,000 per year for
men and 1.2-6/100,000 per year for
women.
2

3. Definition:
 Pneumothorax is defined as
presence of air or gas in the
pleural space
(OR)
 Presence of air outside the lung,
within the pleural space.
3

4. Mechanism:
 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.
(outward pull of the chest wall and
elastic recoil of the lung)
 The negative pressure will
be disappeared if any communication
develops .
4

5.  When a
communication
develops between an
alveolus or other
intrapulmonary air
space and pleural
space, air will flow
into the pleural space
until there is no
longer a pressure
difference or the
communication is
sealed
5

6. Pathophysiology
Negative pressure eliminated
The lung recoil-& lung-volume decrease
V/Q low –anatomic shunt
hypoxia
Positive pressure
◦ Compress blood vessels and heart
◦ Decreased cardiac output
◦ Impaired venous return
◦ Hypotension
Result in
◦ A decrease in vital capacity
◦ A decrease in PaO2
6

7. CLASSIFICATION OF PNEUMOTHORAX
7
Pneumothorax
Spontaneous
Primary Secondary
Traumatic
Iatrogenic
Interventional
procedures.
Positive pressure
ventilation
Non iatrogenic
Penetrating
trauma
Blunt trauma.

8. 8
Clinical type of Pneumothorax
Pneumothorax
Closed
pneumothorax
Open
pneumothorax
Tension
pneumothorax

9. Clinical manifestation:
Dyspnea
Chest pain ( pleuritic)
Uncommon manifestation:
Cough
Hemoptysis
Orthopnea
Cyanosis
Mod tachycardia
9

10. Clinical manifestation
 Tension pneumothorax
◦ Distressed with rapid labored respiration
◦ Cyanosis
◦ Marked tachycardia
 Patient who suddenly deteriorate
clinically,
be suspected in the patient with
◦ Mechanical ventilation
◦ Cardiopulmonary resuscitation
10

11. Physical examination:
◦ Depend on size of pneumothorax
◦ The vital signs usually normal
◦ Unilateral Chest movements
◦ The trachea may be shifted toward the
contralateral side if the pneumothorax is
large
◦ Tactile fremitus is absent
◦ The percussion note is hyper-resonant
◦ The breath sounds are reduced or absent
on the affected side
◦ The lower edge of the liver may be shifted
inferiorly with a right-side pneumothorax
11

12. Lab investigations
and Diagnosis
12

13. Radiological manifestation
CXR in erect position CXR in supine position
13

14. Small Pneumothorax
14

15. 15
Small Pneumothorax

16. 16
Pneumothorax with mediastinal shift

17. CT scanning
It is recommended in difficult cases
such as patients in whom the lungs
are obscured by overlying surgical
emphysema
To differentiate a pneumothorax from
suspected bulla in complex cystic lung
disease
17

18. 18
CT can diagnose easily
Pneumothroax

19. MANAGMENT
 Goals
◦ To promote lung expansion
◦ To eliminate the pathogenesis
◦ To decrease pneumothorax recurrence
 Treatment options according to
◦ Classification of pneumothorax
◦ Pathogenesis
◦ The extension of lung collapse
◦ Severity of disease
◦ Complication and concomitant underlying
diseases
19

20. 20

21. 21
 Inhalation of high concentration of oxygen
may reduce the total pressure of gases in
pleural capillaries by reducing the partial
pressure of nitrogen
 This should increase the pressure gradient
between the pleural capillaries and the
pleural cavity
 Thereby increasing absorption of air from
the pleural cavity
O2 TREATMENT: PSP or SSP

22. 22
 The rate of resolution/re-absorption of
spontaneous pneumothorax is 1.25 –
1.8% of volume of hemi thorax every 24
hours
 The addition of high flow oxygen
therapy has been shown to result in a
4-fold increase in the rate of
pneumothorax reabsorption during the
periods of oxygen supplementation

23. 23
Simple aspiration
 Simple aspiration is recommended as first line
treatment for all PSP requiring intervention
 Simple aspiration is less likely to succeed in
secondary pneumothoraces and in this situation,
is only recommended as an initial treatment in
small (<2 cm) pneumothoraces in minimally
breathless patients under the age of 50 years
 Patients with secondary pneumothoraces
treated successfully with simple aspiration
should be admitted to hospital and observed for
at least 24 hours before discharge

24. 24
 Repeated aspiration is reasonable for
primary pneumothorax when the first
aspiration has been unsuccessful
 A volume of < 2.5 L has been aspirated on
the first attempt
 The aspiration can be used by needle or
catheter
Catheter aspiration

25. Intercostal tube drainage
 INDICATIONS
◦ Unstable
pneumothorax
◦ Severe dyspnea
◦ Large lung collapse
◦ Open or tension
pneumothorax
◦ Recurrent
pneumothorax
◦ Simple aspiration or
catheter aspiration
drainage is
unsuccessful in
controlling symptoms 25

26. 26
 The safest site for
Insertion of a drain
is in the triangle
that lies:
a. Anterior to the mid
axillary line
b. Above the level of
the nipple (fifth
space)
c. Below and lateral
to the pectoralis
major muscle.
Intercostal tube drainage

27. 27
Intercostal tube drainage
Fix the catheter and cover with
gauze
Making a small incision
Using a forceps to extend the
hole
Inserting a catheter into
pleural cavity

28. 28
Observation of drainage
 No bubble released:
◦ The lung re-expansion
◦ The chest tube is obstructed by secretion or blood clot
◦ The chest tube shift to chest wall, the hole of the chest
tube is located in the chest wall
 If the lung re-expand, the chest tube may be removed
24 hours after re-expansion.
 Otherwise, the chest tube will be inserted again or
regulated the position.

29. 29
Surgical treatment
 Indications
◦ No response to medical treatment
◦ Persist air leak
◦ Haemopneumothorax
◦ Bilateral pneumothoraces
◦ Recurrent pneumothorax
◦ Tension pneumothorax failed to drainage
◦ Thicken pleura makes lung unable to re-
expansion
◦ Multiple blebs or bullae

30. Definitive Management of
Pneumothorax
PLEURECTOMY AND
PLEURODESIS
 Surgery for pneumothorax can be performed by
video-assisted thoracoscopic surgery (VATS) or as
an open procedure (thoracotomy).
 The object of the exercise is three-fold:
• to deal with any leaks from the lung;
• to search for and obliterate any blebs and bullae
(Bullectomy);
• to make the visceral pleura adherent to the parietal
pleura so that any subsequent leaks are contained
and the lung cannot completely collapse.
30

31. Pleural adhesion is achieved in
one of three ways:
• Pleurectomy: systematically strip the
parietal pleura from the chest wall.
• Pleural abrasion: a scourer is used to
scrape off the slick surface of the
parietal pleura.
• Chemical pleurodesis: usually talc is
used and is insufflated into the chest
cavity.
31

32. 32
Complications of Pneumothorax
 Pyopneumothorax
 Hydropneumothorax.
 Hemopneumotorax
 Mediastinal and subcutaneous
emphysema

33. Recurrence:
The best estimates of recurrence rates
are:
 • of patients who experience a first event,
only about one-third experience
recurrence;
 • of those who have a second episode,
about one-half go on to experience a
third episode;
 • those who have had three episodes will
probably go on to have repeated
recurrences.
33

34. Thank You!!!
34