Pathology of the chest pneumothorax

1. By: M. Suleiman Aljajeh
1
2014-2015

2. 1. Definition
2. Types
3. Clinical features
4. Risk factors
5. Diagnosis
6. Treatment
7. Complications
2

3.  “Pneumothorax : is an abnormal
collection of air or gas in the pleural
space separating the lung from
the chest wall which may interfere with
normal breathing, causing the lungs to
collapse.”
3

4. 1. Spontaneous pneumothorax:
 Primary: It occurs in young healthy
individuals without underlying lung
disease. It is due to rupture of apical sub-
pleural bleb.
 Secondary: occurs in the presence of pre-
existing lung pathology. Ex : Cystic lung
disease ,COPD, LUNG CANCER &T.B
4

5. 2. Traumatic pneumothorax:
 Open: Chest wall is damaged by any wound -
-outside air enters pleural space and causes
lungs to collapse.
 Closed: here chest wall is punctured or air
leaks from a ruptured bronchus
 Iatrogenic : Ex. Postoperative Mechanical
ventilation ,Thoracocentesis & Central
venous cannulation .
5

6. 3. 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. 6
ER

7. 7

8. The pleural cavity
pressure is < the
atmospheric
pressure
The pleural cavity
pressure is = the
atmospheric
pressure
The pleural cavity
pressure is > the
atmospheric pressure
8

9.  Predominant symptom is acute pleuritic chest pain
 Dyspnoea results form pulmonary compression
 On physical examination:
 Breath sounds may be diminished on the affected side
 Percussion of the chest may be perceived as hyperresonant.
 Physical signs include
 Tachypnoea
 Increased resonance
 Absent breath sounds
 Hypoxemia
 Cyanosis
 Hypercapnia 9

10. 10

11. 11

12.  Sex : men are far more likely to have a pneumothorax than
are women.
 Smoking.
 Age.The type of pneumothorax caused by ruptured air
blisters is most likely to occur in people between 20 and 40
years old, especially if the person is a very tall and
underweight man.
 Genetics.
 Lung disease. Having an underlying lung disease —
especially chronic obstructive pulmonary disease (COPD) —
makes a collapsed lung more likely.
 Mechanical ventilation.
 A history of pneumothorax.
12

13.  The characteristics of
pneumothorax
 Pleural line
 No lung markings in
pneumothorax
13

14.  A further use of CT is in the identification of
underlying lung lesions
14

15. Goals :
To promote lung expansion.
To eliminate the pathogenesis.
To decrease pneumothorax
recurrence.
 Treatment options :
 Simple aspiration
 Intercostal tube drainage
 Guidewire tube thoracostomy
 Surgical treatment
15

16. 16

17. 17

18. 18

19. Complications of pneumothorax
Recurrence of spontaneous pneumothorax
Tension pneumothorax
Hydropneumothorax
Encysted pneumothorax
Failure of expansion of the collapsed lung
Re-expansion pulmonary edema
Broncho-pleural fistula
Pneumomediastinum 19

20. 20

21. 21
1. Kumar and Clark Clinical Medicine
2. USMLE Step 2 CK
3. Harrison's Principles of Internal Medicine

22. 22

23. 23