מרכז רפואי קפלן

1. מרכז רפואי קפלן כירורגית בית החזה

2. Spontaneous Pneumothorax The Overlooked Issue

3. Definition Accumulation of air in the pleural space that leads to partial or total collapse of the affected lung.

4. Spontaneous Pneumothorax Primary Spontaneous Pneumothorax (PSP) Secondary Spontaneous Pneuomothorax (SSP)

5. Epidemiology Young patient (10-30 years) Usually tall and thin Cigarette smoking Normal lung

6. Etiology Localized subpleural blebs (1-2 mm) : 90% upper lobes 10% lower lobes 80% by CT 75% by Surgery Normal lung Recurrence: 16%-54% I episode >83% II episode

7. Clinical Presentation No symptoms Symptoms

8. Clinical Presentation Sudden pleuretic chest pain Dyspnea Classic findings (PE): Diminished breath sound Hyperresonance Fremitus Normal findings

9. Complications Respiratory Failure Pleural fluid 20% ( 3% Hemothorax) Empyema Tension pneumothorax (2%-3%)

10. Imaging Chest radiography CT is seldom required

12. Management Depend on: Size Stability of the patient Symptom complex Initial PSP onset or recurrent episode Presence/absence of structural lung disease

13. Size Rhea JT, DeLuca SA, Greene RE (1982) Belgian Society of Pneumology (2005) SEPAR (2008) British Thoracic Society (2010)

18. How to Treat

19. Treatment-observation Small Px (3 cm) Asymptomatic Monitoring,Physical ex, Pulse oximetry, Repeated x-ray

20. 0.9%-1.25% Intrapleural air absorbed daily

21. Treatment-Aspiration Larger Px Stable Patient Success Rate: PSP 66%-83% SSP 37%

24. Treatment-Thoracostomy Larger (tension) Px Symptomatic (PSP-SSP) PSP 90%,50%,15% Recommended only for definitive management of PSP of the first event

25. Treatment-Surgery Recurrence Large or Persistent air-leak Incomplete lung expansion Bil. SP Occupations risk

26. How To Do

28. It is all ways the size and the consistency that count…

29. THANK YOU