(Acute & Emergency) (Clinical Imaging)

Overview

• Collection of air within the pleural space between the lung (visceral pleura) & the chest wall (parietal pleura)
• Primary Spontaneous → in patients without underlying lung disease
• Secondary Spontaneous → complication of underlying lung disease (eg. COPD)
• Traumatic → caused by trauma (stab wound, gunshot)
• Tension → life-threatening variant. Complication of primary + secondary spontaneous pneumothorax & traumatic pneumothorax. Creates one way valve, air can enter pleural space, but not leave hence shifts trachea and can press on heart.
  • Will cause hypotension due to cardiac outflow obstruction (due to mediastinal shift). Severe hypotension is what causes death.
  • Suspect if sudden deterioration following intubation
• Primary Spontaneous = M>F (6:1), 16-25 yrs old (most common in tall, thin, young males)
• Risk Factors → Smoking, FH, Tall & Slender body, <40 years, Recent invasive medical procedure (Chest drain), Chest Trauma, COPD, Cystic Fibrosis, Marfan’s Disease

Making Diagnosis

Clinical Features:

• Sudden, severe pleuritic chest pain
• Dyspnoea (SOB)
• O/E ⇒ Reduced breath sounds, Hyperresonant percussion, Decreased fremitus (all on ipsilateral side)
• Haemodynamic Instability (tension) → tachypnoea, tachycardia, hypotension