PNEUMOTHORAX
Classification and Etiology and Pathology
- Classified as iatrogenic (following
a specific event) or spontaneous
- Iatrogenic pneumothorax
follows procedures such as lung biopsy, thoracentesis, trauma,
etc.
- Spontaneous pneumothorax can occur in all
lung disease, e.g., lung cancer, emphysema, diffuse interstitial fibrosis, etc.
Spontaneous idiopathic pneumothorax occurs when small blebs of peripheral
tissue rupture without warning or apparent cause. Young people are more
commonly affected. A cough may lead to sudden pain and dyspnea.
- Mechanical ventilation with PEEP predisposes
to development of barotrauma and pneumothorax.
- Spontaneous pneumothorax
also is encountered in patients with apparent normal lungs.
Consider in this group congenital blebs, Marfan's, Ehlers-Danlos Syndrome
and endometriosis.
Clinical Features
- Patients present with sudden
onset of SOB, chest pain and cough.
- Cyanosis, shift of
mediastinum, larger ipsilateral hemithorax, decreased
chest expansion, hyper-resonance and decreased breath sounds are
characteristic physical findings.
- Tension pneumothorax is present when the
air leak is progressive. Venous return decreases resulting in falling
blood pressure, tachycardia, worsening SOB and hypoxemia.
Therapy
- Asymptomatic pneumothorax is due to one time
entry of air into the pleural space and can resolve spontaneously in a few
days. Chest tube is not required in this instance.
- Symptomatic pneumothorax however small, requires
either chest tube or Heimlich valve placement immediately.
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