🎯 Pathology

• air enters the pleural space —> separation of the visceral pleura from the parietal pleura —> the lungs will not be able to expand effectively

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💡 Types

• simple pneumothorax —> no mediastinal shift

  • primary/spontaneous (cause is unknown)

    • tends to affect tall and thin males

    • smoking is a risk factor

  • secondary (there is an underlying cause)

    • underlying lung disease e.g. asthma, COPD, lung cancer

    • connective tissue diseases e.g. Marfan’s syndrome, Ehler-Danlos syndrome

    • iatrogenic due to pleural aspiration, lung biopsy, central line insertion, non-invasive ventilation

    • trauma e.g. road traffic accidents

• tension pneumothorax —> there is a mediastinal shift

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🩺 Clinical features

• symptoms

  • may be asymptomatic

  • if symptomatic, they may experience sudden onset of dyspnoea with or without pleuritic chest pain

  • pleuritic chest pain = pain worse with inspiration and with coughing

• signs

  • signs will be picked up on the AFFECTED side of the lung:

    • reduced chest expansion —> too much air in the pleural space

    • hyper-resonant to percussion —> too much air in the pleural space

    • reduced breath sounds —> lung cannot expand properly

    • no tracheal deviation —> unlike a tension pneumothorax

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🕵️‍♂️ Investigations

• initial

  • erect chest x-ray

• best

  • CT scan (more accurate than a chest x-ray)

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📌 How to measure the size of a pneumothorax

• get an erect chest x-ray

• measure the distance between the visceral pleural and the chest wall at the level of the HILUM

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💆‍♂️ Management (British Thoracic Society 2010)​

• primary pneumothorax

  • no shortness of breath + size < 2 cm —> nothing + follow up in 2-4 weeks

  • if short of breath or size > 2 cm —> aspirate with 16-18G cannula at 2nd intercostal space midclavicular line

    • if failed —> chest drain

  • bilateral pneumothoraces —> chest drain

• secondary pneumothorax

  • if short of breath or size > 2 cm —> chest drain

  • if size 1-2 cm —> aspiration

    • if failed —> chest drain

  • if size < 1 cm —> admit for 24 hours + high-flow oxygen