Presence
of gas in pleural space
CXR-Hypertransluscency without bronchovascular markings with collapse margin
Types
1.Spontaneous
Subtypes-
Open- Lung
and pleural comm. persists(Bronchopleural fistula)
Hydropneumothorax may develope
Closed-Lung and pleural comm. is sealed off
Tension/valvar
Causes of spontaneous pneumothorax-
Primary
pneumothorax-Without lung disease
Secondary-With lung
disease(COPD common) ,ruptured emphysematous bullae or bleb/young, or
tubercular foci
2.Traumatic-Chest injury ,aspiration of pleural fluid
Tension
pneumothorax
- Pneumothorax with +ve
pressure in pleural space
- Communication between lung and pleural space making oneway valve
- Only air entry during inspiration but cannot exit
- Traumatic
- Only this type cause mediastinal shifting to opposite
- Life threatening
- Death due to reduced
CO
Clinical features
Sudden severe unilateral pleuritic chest pain
Rapid progressive breathlessness
Tachycardia ,hypotension ,cyanosis
Coin test-Metallic bell like sound
indicates +ve[Surest sign]
Treatment
Wide bore needle through 2nd anterior intercostal space>Gas>Confirmed>Needle left until thoracostomy tube inserted at 4th/5th/6th space>Connected with underwater seal/Heimlich oneway valve>Remove drain when bubble stops and re inflat lung evidence by CXR>If bubble stops but no lung re inflation>Tube is displaced>Correct the tube>If bubble continues for 5-7 days>Surgery
Advice-No flying ,no diving ,no smoking
Recurrent
pneumothorax
Apical lung bleb
Emyphysematous bullae
Cystic fibrosis
Catamenial pneumothorax-Pneumothorax occuring during
menstruation due to intrapleural endometriosis.
Treatment of recurrent pneumothorax-Pleurodesis, Chemical and surgical/pleurectomy/ablation
Hydropneumothorax
Causes-
Aspiration
Chest injury
Thoracic surgery
Bronchopulmonary fistula
Ruptured lung abcess
Bedsite sign of hydropneumothorax-Hippocratic splash
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