Pneumothorax
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Pneumothorax. Tintinalli Chapter 71. Epidemiology. 20,000 spontaneous ptx every year Risk factors Male Smoker Trimodal peaks: neonates, 20-40 yrs, >40. Pathophysiology. Iatrogenic Trauma or diagnostic procedure Spontaneous Primary: 2/3 No known lung disease Secondary

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Pneumothorax

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Pneumothorax

Pneumothorax

Tintinalli Chapter 71


Epidemiology

Epidemiology

  • 20,000 spontaneous ptx every year

  • Risk factors

    • Male

    • Smoker

    • Trimodal peaks: neonates, 20-40 yrs, >40


Pathophysiology

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


Clinical features

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


Diagnosis

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


Treatment

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


Disposition

Disposition

  • Recurrence

    • Definitive treatment may be required

      • Pleurodesis/VATS

      • High rate of recurrence, lower cost, high success, better quality of life


Iatrogenic ptx

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


Sources

Sources

  • Tintinalli, Ch. 71


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