Pneumothorax

The Common Vein Copyright 2008

Definition

Pneumothorax is a mechanical disorder of the lung and pleural space characterized by the abnormal accumulation of air in the pleural space, with iatrogenic disease and trauma being the leading cause, but uncommonly is associated with spontaneous rupture of a bulla in young thin patients.

The resulting air creates a mechanical disadvantage to lung movement in that the movement of the lung and thus air movement is limitied.  When large it can compromise lung function.

It may be complicated by tension pneumothorax as air that  gets in to the pleural space continues to accumulate without egress and the increasing resulting pressure compresses low pressure cardiovascular structures causing cardiorespiratory difficulty that could end in death if untreated.

The diagnosis is suspected clinicallyand confirmed by CXR.

Treatment depends on the size of the pneumothorax.  When large a pigtail catheter or formal chest is used and when small close observation is necessary.  tension pneumothorax is an emergency and when suspected immediate decompression with a large bore needle should be attempted.

Accumulation of air in the pleural space leading to collapse of the underlying lung can occur spontaneously in tall and slim young adults or in patients with history of emphysema. Such patients usually present with an acute onset of unilateral pleuritic pain that may be associated with dyspnea. Depending on the size of the pneumothorax, it can be managed conservatively by observation or by evacuation of the air through placement of a chest tube.

Tall ThinYoung – Spontaneous Pneumothorax with Mediastinal Shift

This is the type of CXR that sends shivers down the spine. The overall blackness of the left chest cavity, in association with a nubbin of lung tissue in the ipsilateral hilum and rightward mediastinal shift is characteristic of a tension pneumothorax with total atelectasis of the left lung. Immediate and urgent decompression with a chest drain is indicated. One must also remeber that if a tall thin young patient presents with chest pain the diagnosis of dissecting aneurysm in a patient with Marfans syndrome has to be considered.

Courtesy Ashley Davidoff MD 42525 code lung pleura dx tension pneumothorax plain film CXR 5star medical students