Pneumothorax

Aka: Pneumothorax

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II. Types

  1. Spontaneous Pneumothorax (Simple Pneumothorax)
  2. Open Pneumothorax
  3. Tension Pneumothorax
  4. Hemothorax

III. Pathophysiology

  1. Air enters potential space between the visceral pleura and the parietal pleura
  2. Tension Pneumothorax may result
    1. Air accumulates in the pleural space with each breath taken
    2. Pressure compresses the lung tissue and inhibits venous return with secondary decreased Cardiac Output

IV. Causes: Adults

  1. Blunt Chest Trauma
    1. Most common cause of sports-related Pneumothorax
    2. Consider other concurrent injuries (e.g. Pulmonary Contusion)
  2. Penetrating Chest Trauma
  3. Spontaneous Pneumothorax
  4. Iatrogenic Pneumothorax (secondary to medical procedure)

V. Risk Factors: Newborns (1-3% of births)

  1. Premature Infant
  2. Respiratory distress syndrome
  3. Meconium Aspiration Syndrome

VI. Signs

  1. See Spontaneous Pneumothorax (Simple Pneumothorax)
  2. See Open Pneumothorax
  3. See Tension Pneumothorax
  4. Decreased breath sounds
  5. Hyperresonance to percussion

VII. Imaging

  1. See Pneumothorax Imaging
  2. Chest XRay
    1. Upright and end expiratory films are preferred
    2. Supine Chest XRay is unreliable and likely to yield a False Negative study
    3. Even large pneumothoraces on CT may be missed on Chest XRay
      1. Rodriguez (2019) Ann Emerg Med 73(1):58-65 +PMID:30287121 [PubMed]
  3. Ultrasound
    1. See Lung Ultrasound for Pneumothorax (Sliding Lung Sign)
    2. Part of Extended FAST Exam
  4. Chest CT
    1. See Nexus Chest CT Decision Rule in Blunt Trauma
    2. Gold standard in Pneumothorax
    3. Indicated where Chest XRay cannot distinguish bleb in COPD from Pneumothorax
    4. Identifies associated Traumatic Injury (e.g. multiple contiguous Rib Fractures)

VIII. Precautions

  1. Until a Chest Tube is placed, Tension Pneumothorax is a risk
  2. Do not perform Positive Pressure Ventilation, general Anesthesia or air transport until Pneumothorax decompression
  3. Consider Esophageal Rupture in the injured patient with a left Pneumothorax or Hemothorax without a Rib Fracture

IX. Management

  1. See Trauma Evaluation
  2. See Spontaneous Pneumothorax (includes disposition and restrictions)
  3. See Tension Pneumothorax
  4. See Open Pneumothorax
  5. See Hemothorax
  6. Non-Traumatic Pneumothorax
    1. See Spontaneous Pneumothorax
  7. Traumatic Pneumothorax
    1. Chest Tube at 4-5th intercostal space at the mid-axillary line
      1. Confirm Chest Tube placement with Chest XRay
    2. Outside of Hemothorax (and hemopneumothorax), Small Caliber Chest Tubes appear safe in uncomplicated Traumatic Pneumothorax
      1. Small Caliber Chest Tubes are as effective and significantly less painful than standard Chest Tubes in Pneumothorax
      2. Kulvatunyou (2014) Br J Surg 101(2): 17-22 [PubMed]

X. Complications

  1. Tension Pneumothorax

XI. References

  1. Noppen (2003) Respiration 70(4): 431-8 [PubMed]
  2. Majoewsky (2012) EM:RAPC3 2(2): 3-4
  3. Tranchell (2013) Crit Dec Emerg Med 27(7): 11-8

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Related Studies

Ontology: Pneumothorax (C0032326)

Definition (MSH) An accumulation of air or gas in the PLEURAL CAVITY, which may occur spontaneously or as a result of trauma or a pathological process. The gas may also be introduced deliberately during PNEUMOTHORAX, ARTIFICIAL.
Definition (MSHCZE) Přítomnost vzduchu v pleurální dutině, s následným smrštěním (kolapsem) plíce, zhoršením dýchání a nebezpečím hypoxie. Vzduch do pohrudniční dutiny proniká např. při úrazu (traumatický p., zevní p.) nebo při roztržení plíce poškozené onemocněním (prasknutí buly při emfyzému), někdy není příčina zřejmá. Pneumotorax bez zevní vyvolávající příčiny se označuje jako spontánní. Stav se projevuje dušností, bolestí na hrudi, suchým kašlem, v těžkých případech pak selháváním dechových funkcí a oběhu. Závažný je pneumotorax ventilový, kdy při každém nádechu vniká do hrudníku vzduch, který se „ventilově fungujícím“ otvorem nedostane ven; dochází k nárůstu tlaku a kompresi srdce a velkých cév (přetlakový pneumotorax). V některých případech se vzduch sám vstřebá, u jiných je nutný složitější zákrok (odsávání vzduchu, drenáž). Pneumotorax se někdy užíval i léčebně (arteficiální, terapeutický pneumotorax), klasicky při tuberkulóze. (cit. Velký lékařský slovník online, 2012 http://lekarske.slovniky.cz/ )
Definition (NCI_CTCAE) A disorder characterized by abnormal presence of air in the pleural cavity resulting in the collapse of the lung.
Definition (NCI) Abnormal presence of air in the pleural cavity.
Definition (NCI_CDISC) Abnormal presence of air in the pleural cavity.
Definition (CSP) accumulation of air or gas in the pleural space, which may occur spontaneously or as a result of trauma or a pathological process.
Concepts Disease or Syndrome (T047)
MSH D011030
ICD10 J93 , J93.9
SnomedCT 155612006, 155609008, 196106000, 36118008
LNC LA7466-1
English Pneumothorax, pneumothorax disorder, Pneumothorax NOS, Pneumothorax, unspecified, pneumothorax, pneumothorax (diagnosis), Pneumothorax [Disease/Finding], free air in the chest outside the lung, Pneumothorax NOS (disorder), Air in pleural space, PNEUMOTHORAX, Pneumothorax (disorder), Pneumothorax, NOS
French PNEUMOTHORAX, Pneumothorax SAI, Pneumothorax, Pneumothorax spontané
Portuguese PNEUMOTORAX, Pneumotórax NE, Pneumotórax
Spanish NEUMOTORAX, Neumotórax NEOM, neumotórax, SAI (trastorno), Pneumothorax NOS, neumotórax, SAI, neumotórax (trastorno), neumotórax, Neumotórax
German PNEUMOTHORAX, Pneumothorax NNB, Pneumothorax, nicht naeher bezeichnet, Pneumothorax
Dutch pneumothorax NAO, Pneumothorax, niet gespecificeerd, pneumothorax, Pneumothorax, Thorax, pneumo-
Italian Pneumotorace NAS, Pneumotorace
Japanese 気胸, 気胸ＮＯＳ, ｷｷｮｳNOS, ｷｷｮｳ
Swedish Luft i lungsäcken
Czech pneumotorax, Pneumotorax NOS, Pneumotorax, pneumothorax, PNO
Finnish Ilmarinta
Russian PNEVMOTORAKS, ПНЕВМОТОРАКС
Korean 상세불명의 공기가슴증, 공기가슴증
Croatian PNEUMOTORAKS
Polish Odma opłucnowa
Hungarian Pneumothorax, Pneumothorax k.m.n.
Norwegian Pneumothorax, Luft i lungesekken, Punktert lunge
Derived from the NIH UMLS (Unified Medical Language System)

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