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03-18-2009, 10:36 AM
Pneumothorax
Def.: Air within pleural cavily
Etiological types:
I. Spontaneous pneumothorax.
II. Traumatic pneumothorax
III. Artificial pneumothorax
pathological types: according to intrapleural pressure
Closed Pneumothorax :

Air within pleura with no communication with atmosphere
e.g. Rupture bleb mild ­ in pleural pressure, it is usually absorbed
air

II- open pneumothorax:
e.g. Trauma bronchopleural fistula (air within pleura communicating with atmosphere) so, with inspiration -ve Pr. air input into pleura mild compression on the lung during expiration Pleural pressure ­­ with output of air from pleura to bronchus to outside.

So, there is mild compression on the lung

III-Tension pneumothorax = (valvular mechanism)
Tear of pleura acts as valve like this allow air input without output Severe compression on lung pressure in pleural cavity ­­ (emergency) as there is also compression of the mediastinum and its contents.
1-Spontaneous pneumothorax
Aetiology :
Rupture bleb or rupture of subpleural emphysematous bulla.
Asthma ( severe asthmatic attack)
Rupture of subpleural T.B cavity

C/P Of pneumothorax (generally)

Symptoms
1. Sudden onset of chest pain & something gives way.
2. Anxiety
3. Severe dyspnea with severe cases
4. Manifestations of the cause.

Signs
Mild no signs (diagnosed by X ray)
Severe Inspection Movement
Palpation TVF , Expansion
Percussion Hyper resonance
Auscultation air entery
Q D.D.of chest pain + shock?
Tension pneumothorax
Massive pulmonary embolism
Extensive M. I
Dissecting. Aortic. Aneurysm

Investigation:
1- X-ray chest
2- Measure the intrapleural pressure.

Treatment

1- Cause.
2- intercostal tube under H2O seal.
this tube inserted for no> 48-72 hrs to avoid infection








N.B: In recurrent pneumothorax, do pleurodesis by intrapleural injection of glucose or tetracycline also used in malignant effusion resistant to treatment.
2- Traumatic pneumothorax
Etiology +Thoracocentesis
+Mechanical ventilation
+(Penetrating chest trauma)
C/P as before
Investigations as before
Treatment as before + ttt of cause.

3- Artificial pneumothorax
It was used in treatment of T.B.

Artificial pneumothorax
Cause : any cause especially. traumatic
Path. : as before The coin test
: as before esp. symptoms & signs Marked dyspnea
shock
Treatment: 1st aid put wide bore needle in the 2nd space MCL to change it to open pneumothorax then intercostal tube under water seal as before.
D. D chest pain + shock


Pneumo mediastinum (mediastinal emphysema,)
Air introduced within mediastinum
Cause Trauma
Rupture trachea
Rupture oesophagus
C/P l- Chest pain
2- Cardiac compression
Signs Auscultation

Crunching sound with heart beats (Hamman sign)

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)