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Pneumothorax.pptx
This document provides tips and instructions for using a PowerPoint presentation on pneumothorax. The presentation contains blank slides where students can provide their knowledge on topics before seeing the slides with information. Using this active learning technique over three revisions will make for an effective self-study or teaching session. The presentation covers definitions, causes, mechanisms, clinical features, diagnosis and management of pneumothorax. QR codes and links are also provided to access the full presentation on mobile devices or download additional teaching materials.
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Pneumothorax.pptx
- 1. Tips on usingmy ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. 7. See notes for bibliography.
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- 4. Pathophysiology • The probablecause of pneumothorax is rupture of an apical bleb or bulla • Smoking causes a 9-fold increase in the relative risk of a pneumothorax in females • A 22-fold increase in male smokers 4
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- 6. Mechanism • In normalpeople, the pressure in pleural space is negative during the entire respiratory cycle. • When a communication develops between pleural space, and intrapulmonary air space or exterior and air will flow into the pleural space until there is no longer a pressure difference or the communication is sealed – Compress lungs,blood vessels and heart – Decreased cardiac output – Impaired venous return – Hypotension 6
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- 8. Etiology Pneumothorax Spontaneous Primary Secondary Traumatic Iatrogenic Interventional procedures. Positive pressure ventilation Noniatrogenic Penetrating trauma Blunt trauma.
- 9. Primary spontaneous pneumothorax •It occurs in young healthy individuals without underlying lung disease • It is due to rupture of apical sub-pleural bleb or bullae Predisposing factors: Smoking. Tall, thin male. Airway inflammation (distal) Structural abnormalities of bronchial tree Genetic contribution 9
- 10. Secondary spontaneous pneumothorax Commoncauses. • TB • Asthma • COPD • Suppurative pneumonia • Cystic fibrosis • Rare cause • ILD • Eosinophilic granuloma • Sarcoidosis • Lymphangioleiomyomatosis • AIDS. 10 • Primary lung carcinoma • Complication of chemotherapy • Connective tissue disease • Scleroderma • Marfans syndrome • Histiocytosis- x • Rheumatoid disease • Pulmonary infarct • Wegener’s granulomatosis…
- 11. Traumatic pneumothorax Accidental trauma:(non-iatrogenic) Blunttrauma: with fracture ribs. Penetrating trauma: stab wound or gun shot injury. Iatrogenic : Positive pressure ventilation: Alveolar rupture interstitial emphysema pneumothorax.(B/L PNX) Interventional procedures: Biopsy, thoraco-centesis, CVP line,trachestomy etc.. 11
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- 13. Clinical Features Constant • Dyspnea •Chest pain ( pleuritic) Uncommon manifestation • Cough • Hemoptysis • Orthopnea • Cyanosis • Tachycardia • Anxiety, • vague presenting symptoms (eg, general malaise, fatigue) 13
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- 15. 15 Closed pneumothorax Open pneumothorax Tension pneumothorax The pleural tear Issealed The pleural tear is open The pleural tear 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
- 16. Tension pneumothorax • Tensionpneumothorax is classically characterized by hypotension and hypoxia.
- 17. Tension pneumothorax • Itis life threatening condition. • Rapidly progressive breathlessness and circulatory collapse (tachycardia, hypotension & sweating). • Jugular venous distention • The pleural pressure is more than the atmospheric pressure. Radiological manifestations of large pneumothorax • Mediastinal shift, • Flattening of the hemidiaphragm & • Lung collapse. It is more common with • Positive pressure ventilation & • Traumatic pneumothorax.
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- 19. Clinical features: INICU – Patients on Mechanical ventilation or cardiopulmonary resuscitation who suddenly deteriorate clinically,with – RAPIDLY PROGRESSIVE DYSPNOEA. – Cyanosis – Marked tachycardia – Hypotension – The airway pressure alarms are triggered.
- 20. Physical examination • Dependon 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 hyperresonant • 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
- 21. Pneumothorax in erect position Pneumothorax insupine position Air in apicolateral pleural space Air in anteromedial pleural space.
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- 27. DD of visceralpleural line Skin fold: • Positive mash band (optical edge enhancement). • Extend beyond the chest wall. • Lung markings extend beyond it.
- 28. DD of visceralpleural line Scapular edge
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- 31. CT scanning It isrecommended 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 31
- 32. CT can diagnoseeasily pneumothroax
- 33. CT can diagnoseeasily pneumothroax
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- 36. U/S in pneumothorax •Ultrasound found to be more sensitive than CXR in diagnosis of pneumothorax.
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- 38. Treatment Traumatic pneumothorax • Intercostaltube drainage for trauma. • Aspiration is the technique of choice for iatrogenic pneumothoraces, because recurrence is usually not a factor. Tube thoracostomy is reserved for very symptomatic patients.
- 39. 43 Simple aspiration Simpleaspiration 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 should be admitted to hospital and observed for at least 24 hours before discharge.
- 40. 44 Repeated aspirationis reasonable for primary pneumothorax when the first aspiration has been successful A volume of < 2.5 L has been aspirated on the first attempt The aspiration can be done by needle or catheter Catheter aspiration
- 41. Chemical pleurodesis 45 Goals •To prevent pneumothorax recurrence • To produce inflammation of pleura and adhesions • Indications: • Persistent air leak and repeated pneumothorax • Bilateral pneumothorax • Complicated with bullae • Lung dysfunction, cannot tolerate operation.
- 42. Surgical treatment 46 Indications ◦No response to medical treatment ◦ Persistant air leak ◦ Hemopneumothorax ◦ Bilateral pneumothoraces ◦ Recurrent pneumothorax ◦ Tension pneumothorax failed to drainage ◦ Thickened pleura making lung unable to reexpand ◦ Multiple blebs or bullae
- 43. Complications of pneumothorax Recurrenceof spontaneous pneumothorax Tension pneumothorax Hydropneumothorax Encysted pneumothorax Failure of expansion of the collapsed lung Re-expansion pulmonary edema Broncho-pleural fistula Pneumomediastinum
- 44. Recurrence of spontaneous pneumothorax •50% on the same side. • 15% on the contralateral side. More common in • secondary spontaneous pneumothorax.
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- 46. Tension pneumothorax: Management • Aspirationfollowed by ICD
- 47. Catamenial pneumothorax • Catamenialpneumothorax is a condition of pneumothorax occurring in conjunction with menstrual periods(catamenial - menstruation), believed to be caused primarily by endometriosis of the pleura
- 48. Get this pptin mobile 1. Download Microsoft PowerPoint from play store. 2. Open Google assistant 3. Open Google lens. 4. Scan qr code from next slide.
- 49. Get this pptin mobile
- 50. Get my pptcollection • https://www.slideshare.net/drpradeeppande/ edit_my_uploads • https://www.dropbox.com/sh/x600md3cvj8 5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl =0 • https://www.facebook.com/doctorpradeeppa nde/?ref=pages_you_manage
Editor's Notes
- #2 drpradeeppande@gmail.com 7697305442