Pneumothorax Cause, Symptoms, Diagnosis, Treatment

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Pneumothorax Definition, Pneumothorax Classification, Pneumothorax Cause, Pneumothorax Symptoms, Pneumothorax Diagnosis, Pneumothorax Treatment, Spontaneous Pneumothorax, Traumatic Pneumothorax, NHM CHO Notes, Community Health Officer,

Pneumothorax Definition

The presence of air within the pleural cavity is called as Pneumothorax.

Pneumothorax Classification

1) Spontaneous Pneumothorax

  • Primary Pneumothorax
  • Secondary Pneumothorax

2) Traumatic Pneumothorax

  • Non-iatrogenic Pneumothorax
  • Iatrogenic Pneumothorax

Spontaneous Pneumothorax

Pneumothorax occurring in the absence of trauma may be described as spontaneous. 

Presents in 3 ways: 

  • Open Pneumothorax- air moves freely in & out of pleural space during breathing. 
  • Closed pneumothorax- no movement of air from the pleural space due to the closure of the communication, air slowly gets absorbed & the lung re-expands.
  • Tension pneumothorax- a check – valve mechanism is produced; this allows air to enter the pleura & accumulate to raise the intrapleural pressure above the atmospheric pressure and leads to compression on the lung & shifting of mediastinum to the opposite side.

1) Primary spontaneous pneumothorax

  • Commonly occurs in healthy subjects with no h/o of pre-existing lung disease.
  • The disease of young adults.

2) Secondary spontaneous pneumothorax

  • Coexisting structural or functional abnormality in the lung.
  • Stature.

Causes of Pneumothorax

Primary spontaneous

  • Apical Blebs (90%)
  • Stature

Secondary spontaneous – less common

  • Chronic bronchitis & emphysema, (35%).
  • Asthma (0.8).
  • Suppurative pneumonia-like Staphylococci, Klebsiella, HIV (2-4%).
  • TB of lungs.

Traumatic Iatrogenic

  • Paracentesis thoracic (28%).
  • Central venous cannulation (22%).
  • Barotrauma (mechanical ventilation).
  • Tracheostomy.

Traumatic Non-Iatrogenic Pneumothorax

  • Open & closed chest injury, (road traffic accident).
  • Stab or gunshot wounds.
  • Rib fractures.

Pneumothorax Symptoms

  1. Small pneumothorax is asymptomatic.
  2. Chest pain – Sharp unilateral associated with shortness of breath is the commonest presentation.
  3. Sharp & stabbing Chest pain exacerbated by deep inspiration & postural change.
  4. Anxious, restless, tachypnoeic, struggling for breath, rapid low volume pulse & hypotension.
  5. May large pneumothorax produce respiratory distress, signs of shock.
  6. Closed pneumothorax –usually does not produce severe symptoms.
  7. Tension pneumothorax – a medical emergency.
Pneumothorax Definition, Pneumothorax Classification, Pneumothorax Cause, Pneumothorax Symptoms, Pneumothorax Diagnosis, Pneumothorax Treatment, Spontaneous Pneumothorax, Traumatic Pneumothorax, NHM CHO Notes, Community Health Officer,

Pneumothorax Physical signs 

  • Small pneumothorax – Difficult to detect on physical examination.
  • Absence or diminished breath sounds on the affected side.
  • Chest movement diminished on the affected side
  • Decreased vocal fremitus.
  • Hyper resonant percussion notes.
  • Ipsilateral enlargement of the chest due to decrease elastic recoil of the collapsed lung.
  • The shift of mediastinum on the opposite side.
  • Increased JVP.
  • Respiratory distress.
  • Diaphoresis
  • Cyanosis.
  • Hypotension.
  • Crepitus is seen if there is associated subcutaneous emphysema.

Pneumothorax Diagnosis

  1. ECG – Diminished anterior QRS amplitude.Radiographic appearances.
  2. X-ray chest – sharply defined lung edge convex outwards separated from chest wall by translucency with no lung markings & mediastinal displacement depending upon the extent of pneumothorax.

Pneumothorax Differential diagnosis

  • Transmural myocardial infarction-ECG changes & left-sided pneumothorax changes resolve once re-expansions.
  • Emphysema confused with pneumothorax but an x-ray is the main diagnostic tool.
  • Massive emphysematous bulla or congenital cyst, when ruptures may be confused with pneumothorax but the previous x-ray, lateral decubitus view is helpful in differentiating upper lobe bulla/cyst.

Pneumothorax Complications

  • Recurrence,
  • Haemopneumothorax,
  • Pyopneumothorax, 
  • Respiratory failure – when tension pneumothorax present.

Pneumothorax Treatment

Treatment depends on cause, size, degree of physiological derangement. A primary pneumothorax-smaller without pleural air leak may resolve spontaneously.

  • If pneumothorax small but the patient mild symptomatic, admit the patient & administer high–flow oxygen, resulting in nitrogen gradient will speed resorption.
  • If pneumothorax larger than 15% to 20% or more than mildly symptomatic, insert a thoracostomy tube.
  • Secondary pneumothorax – Patients are symptomatic & require lung re-expansion.
  • Often bronchopleural fistula persists & larger thoracostomy tube & suction are required.
  • Iatrogenic pneumothorax – Due to barotrauma from mechanical ventilation always persistent air leak & should be managed with a chest tube & suction.
  • Tension pneumothorax – decompress the affected hemithorax immediately with a 14-gauge needle attached to a fluid-filled syringe, release of air with clinical improvement confirms the diagnosis. Seal chest wound with an occlusive dressing & arrange the placement of a thoracostomy tube.


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