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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

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