20 Pneumothorax and Pleural Effusion Flashcards Preview

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A pneumothorax is caused when the chest wall or the lung is breached. Explain how:

Communication created between pleural space and atmosphere

Air drawn in due to relatively negative pressure in pleural space

Lung collapses due to unopposed elastic recoil



Define a pneumothorax

Presence of air between the visceral and parietal pleura


How can a pneumothorax be caused (ie where does the air come from- orgin of pathology) 


How is a primary, spontaneous pneumothorax created? What are the risk factors for it?

Most cases: small-subpleural bleb/bulla that bursts

Risk factors:

  • Smoking (increases risk x9)
  • Common in young, tall, thin males 


List some of the causes of a secondary pneumothorax:

(3 categories: underlying lung disease, trauma, iatrogenic) 


With a simple pneumothorax, what is likely to be the presenting history? What condition might the history be similar to?

Sudden onset

Pleuritic chest pain and breathlessness

+/- history of lung diseasse/trauma

Similar history: pulmonary embolism


On examination, what are you going to find with a simple pneumothroax (think resp examination) 


What pathology does this x-ray show? Explain your reasoning:


What pathology is shown in the following CT scan?


If a patient has a simple pneumothorax, how should it be treated?

  1. Small: might seal itself off- air ends up in blood stream
  2. Small: needle aspiration might be suficient
  3. Large: insertion of chest drainage 


How do you know where to insert a chest drainage for a large pneumothorax?

  • 5th intercostal space
  • Mid-axillary line
  • Just above 6th rib


How does the chest drain work?

Connection between chest drain and underwater seal

On expiration- won't have bubbles in water once healed 

On inspiration- water seal prevents entrapment of room air 


Define a tension pneumothorax and how can it be caused?

Any size of pneumothorax causing mediastinal shift and cardiovascular collapse

Cuased by an aetiology (anything can progress to it



A tension pneumothorax can lead to hypoxaemia and haemodynamic compromise which is life threatening. Explain how:

  1. Mediastinal shift- compress normal lung
  2. Increased intrapleural pressure- can't draw air in
  3. Venous return=impaired
  4. CO drops



What are the signs and symptoms of a tension pneumothorax?



What is shown in the following x-ray? Why should this x-ray not have been taken? 

With tension pneumothorax- diagnosis=clinical

NO TIME for CXR for confirmation- need emrgency decompression of chest 


How is a tension pneumothorax treated?


What is a pleural effusion? 

Excess of fluid in pleural cavity

Imbalance in normal rate of fluid production and absorption

Fluid= transudate/exudate


Define the following: haemothorax, chylothorax, empyema


How is pleural fluid usually produced and absorbed? What forces is this dependent on?

Production: 2400ml by paritel pleura

Absorption: by lymphatics


Depends on:


Hydrostatic pressure and colloid osmotic pressure 



Differentiate between the possible caused of a transudate pleural effusion and an exudate pleural effusion.


When testing a sample of transudate vs exudate- how can we tell which is which?


What history is a patient with a pleural effusion likely to present with?

  • Breathlessness- gradual onset (days)
  • Chest pain- pleuritic 
  • +/- features of causative disease eg lung malignancy/congestive cardiac failure 


What are you likely to find on examination with a pleural effusion?


What is shown in the following x-ray?

Pleural effusion in right lung 



If a patient has a suspected pleural effusion why is it useful to do a CT scan?

Detect underlying pathology and confirm effusion


In general is a bilateral pleural effusion more likely to be due to exudate or transudate?

Bilateral= more likely transudate and more systemic conditions

Unilaterall= more likely to be exudate as more localised 


How do we reach a diagnosis of the cause of a pleural effusion?


How do we treat a pleural effusion?

  • Treat underlying condition
  • If very symptomatic--> chest aspiration
  • Recurrent effusion- may require:
    • indwelling pleural catheter
    • Pleurodesis: obliteration of pleural space- visceral and parietal= adherent