![]() ![]() Īsymptomatic patients with pneumothorax as an incidental finding may not need any intervention unless an estimated risk of recurrence is high. The principles of treatment of pneumothorax: air elimination, reduction of air leakage, healing of pleural fistula, promoting re-expansion of the lung, prevention of future recurrences. The management is guided by the etiology, clinical presentation, and risk stratification. small pneumothorax is by the distance between the lung margin and chest wall : In fact, ultrasound can rapidly diagnosis pneumothoraces with better accuracty than standard chest X-ray, while sparing the patient radiation expsoure. Point of care ultrasound is commonly used in the evaluation patients with pneumothorax. The diagnosis is often made by upright chest radiograph, except tension pneumothorax which is a clinical diagnosis. In patients who present with sudden onset of sharp pleuritic chest pain and shortness of breath, spontaneous pneumothorax should always be on a differential diagnosis list. However, small pneumothoraces are often missed on physical exam and chest X-ray and may be present on CT chest during a diagnostic workup for other injuries. Adequate history, physical exam and chest X-rays are the mainstays of the diagnosis. Traumatic pneumothorax must be a suspected diagnosis in any blunt or penetrating chest trauma. On physical exam, the patient has absent breath sounds on the affected hemithorax, tracheal deviation to the contralateral side, tachycardia, and jugular venous distention - undiagnosed and untreated tension pneumothorax results in hemodynamic collapse and death. The gradual accumulation of air in the pleural space due to one-valve situation causes the shift of the mediastinum to the contralateral side and compression of vena cava and eventual compromise of the cardiac output, producing life-threatening hypotension and hypoxia. The patient may have profound hypoxia and hypotension. Tension pneumothorax, besides chest pain and shortness of breath, presents with hemodynamic compromise. The signs and symptoms of tension pneumothorax are more severe, and timely diagnosis and treatment are crucial for the patient's survival. Many patients with first time spontaneous pneumothorax do not seek medical help for several days. However, with large enough pneumothorax, there may be absent breath sounds on the affected side. The patient may have a normal physical exam if the pneumothorax is small. Patients can also present with anxiety and cough, but these symptoms are less common. Symptomatic onset is sudden, and in primary spontaneous pneumothorax can decrease after 24 hours, possibly due to gradual spontaneous resolution of the pneumothorax. Chest pain is usually severe, sharp/stabbing, pleuritic and radiates to ipsilateral shoulder/arm. The most common presenting symptoms are chest pain and shortness of breath (64 to 85%). Some patients may be asymptomatic, and pneumothorax is diagnosed as an incidental finding during the workup for another condition. The clinical presentation varies depending on the etiology and the size of the pneumothorax. It occurs when a chest injury causes a one-valve situation when the air gets into the pleural cavity but is unable to escape freely and thus gets trapped. ![]() Tension - progressive accumulation of air in the pleural cavity causing the shift of mediastinum to the opposite side, resulting in compression of vena cava and other great vessels, decreased diastolic filling, and ultimately compromised cardiac output. This loss of the chest wall integrity can create an air sucking and a paradoxical lung collapse, thus causing significant ventilatory problems.ģ. Communicating - when there is a defect in a chest wall, such as from a gunshot wound, that causes open communication with an outside atmosphere. An example is a pleural laceration from a fractured rib.Ģ. Simple - when the air in the pleural space does not communicate with an outside atmosphere, and there is no shift in mediastinum or hemidiaphragm. Pneumothorax can also be classified based on their physiology into the following types:ġ. Spontaneous - a pneumothorax without any apparent cause or inciting event. Iatrogenic - caused by manipulation by a healthcare provider, such as the insertion of central lines, etcģ. Majority of all pneumothoraces are traumatic in originĢ. Traumatic - resulting from blunt or penetrating chest trauma. Pneumothorax can subdivide into three broad categories according to the etiology:ġ. Pneumothorax - is an accumulation of air or gas in the pleural space (the space between visceral and parietal pleura of the chest cavity), which can impair with ventilation, oxygenation, or both. This condition can vary in its presentation from asymptomatic to life-threatening. ![]()
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