Pneumothorax | Lecture Note

University:
The University Of Western Ontario
Course:
ANAT 2200B | Systemic Anatomy of the Human Body
Academic year:

2022
Views:

197

Pages:

3
Author:

Kyuwon J.

Pneumothorax ● Air in the pleural space → lung partially or fully collapses ● Loss of negative pressure ● Simple pneumothorax ○ Air enters pleural space ■ No progressive pressure buildup ○ Spontaneous ■ Primary ● No known lung disease ■ Secondary ● Underlying lung disease ■ Traumatic ● Rib fracture ● Penetrating injury ■ Latrogenic ● Procedure-related ● Tension pneumothorax - Emergency ○ One-way valve effect ■ Air enters pleural space during inspiration ■ Cannot escape during expiration ○ Increase in pressure → ipsilateral lung collapses and mediastinum shifts away and venous return drops ● Pneumothorax causes shock ○ Rise in intrathoracic pressures compresses various parts ■ SVC and IVC ● Reduction of venous return ■ Heart filling ● Right side ■ Obstructive shock pattern ● Exam finding ○ Simple pneumothorax ■ Sudden pleuritic chest pain and dyspnea ■ Percussion ● Hyper-resonant ■ Breath sounds ● Reduced or absent on affecting side ■ Reduced fremitus ■ Trachea in the midline ● Unless large ○ Tension pneumothorax ■ Critical ■ Severe dyspnea and distress ■ Hypotension ■ JVP up - possibility ■ Tracheal deviation away from affected side ● Late-ish sign ■ Hyper-resonance + absent breath sounds on affected side ● Imaging clues ○ CXR ■ Pleural line visible ● No lung marking beyond ● Collapsed lung edge pulled towards hilum ■ When in tension ● Mediastinal shift + depression of hemidiaphragm