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Case 22: Spontaneous Pneumothorax
Terms in this set (12)
What is the classic presentation for a spontaneous pneumothorax?
A young, tall and skinny, male smoker who presents with sudden onset unilateral chest pain, tachycardia and tachypnea. There will be decreased breath sounds on the affected side and hyperresonance to percussion.
What is the most likely cause for a spontaneous pneumothorax?
Rupture of subcutaneous blebs
What is the definition of a pneumothorax?
A condition where air enters into the pleural space, preventing reexpansion of the lung parenchyma
What is the definition of a tension pneumothorax?
A pneumothorax where air enters into the pleural space and cannot exit due to an increase in pressure.
What is the definition of an open pneumothorax?
A full thickness injury to the chest resulting in air being sucked directly through the chest wall.
What is the definition of flail chest?
Injury to multiple ribs leading to paradoxical inward movements with inhalation
What is the initial management for a pneumothorax that is less than 15% collapsed?
Observation, with intervention if symptoms start to develop
What is the initial managment for a pneumothorax greater than 15%?
Thoracentesis followed by tube thoracostomy
What is the typical cause of secondary spontaneous pneumothorax?
COPD, but it can also be due to malignancy, tuberculosis, PJP, asthma, sarcoidosis, or cystic fibrosis
What is the reocurrance rate for a spontaneous pneumothorax?
30%, or 50% after 2, of 80% after three
What are reasons that a person with a pneumothorax should be taken to surgery?
If there is persistent air leak after 3 days, if there is recurrence, if the patient lives in a remote area, or if they have a high risk job such as a scuba diver or aviator.
What surgeries are typically done for pneumothorax?
VATS with bleb resection and mechanical pleurodesis or an open thoracotomy with bleb resection and mechanical pleurodesis
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