Pneumothorax

1
Pneumothorax

• Tintinalli Chapter 71

2
Epidemiology

• 20,000 spontaneous ptx every year
• Risk factors
• Male
• Smoker
• Trimodal peaks neonates, 20-40 yrs, gt40

3
Pathophysiology

• Iatrogenic
• Trauma or diagnostic procedure
• Spontaneous
• Primary 2/3
• No known lung disease
• Secondary
• Underlying lung disease
• Air enters potential space between parietal and
  visceral pleura

4
Clinical features

• Symptoms relate to size of ptx, rate of
  development, underlying clinical status
• Acute pleuritic chest pain, dyspnea, ? BS
• Tachycardia, tachypnea, hypotension if large and
  have underlying disease
• Tension tracheal deviation and hemodynamic
  compromise
• Hypoxia

5
Diagnosis

• Imaging
• CXR
• 83 sensitivity
• CT
• May be needed to confirm if small
• US
• Signs of pneumo on US include
• Absence of lung sliding
• Multiple horizontal artifact lines
• Absence of vertical comet tail artifacts

6
Treatment

• Small and stable ptx
• May be able to monitor with no intervention
• Catheter aspiration
• Small sized catheter
• Cook catheter
• Uresil
• Chest tube thoracostomy
• Large, secondary ptx, recurrent ptx, abnormal
  vitals

7
Disposition

• Recurrence
• Definitive treatment may be required
• Pleurodesis/VATS
• High rate of recurrence, lower cost, high
  success, better quality of life

8
Iatrogenic PTX

• Transthoracic needle procedures (thoracentesis
  and transthoracic needle bx)
• 50
• Subclavian vein lines
• 25
• Factors
• Underlying disease, body habitus, operator
  experience
• Post procedure CXR may miss since may be delayed
  presentation
• Treatment
• Chest Tube

9
Sources

• Tintinalli, Ch. 71