22 Questions
What is a characteristic of a closed pneumothorax?
The opening in the lung is very small, hence it heals rapidly
What is a sign of a pneumothorax?
Hyper-resonance on percussion
In which situation is needle aspiration of pneumothorax more likely?
The patient has a primary spontaneous pneumothorax and is clinically stable
What is a consequence of a pneumothorax?
Decrease venous return to the heart
What is a characteristic of pleural pressure in a pneumothorax?
Pleural pressure is greater than atmospheric pressure
What is a sign of tension pneumothorax?
Mediastinal shift to the opposite side
What is the primary reason for mediastinal shift to the opposite side in a pneumothorax?
Lung collapse
Which of the following symptoms is most likely to be present in a patient with a spontaneous pneumothorax secondary to preexisting lung disease?
Dramatic presentation
What is the characteristic sound heard on percussion in a patient with pyo-pneumothorax?
Crackpot sound
What is the primary factor that determines the severity of symptoms in a patient with pneumothorax?
Amount of air leakage
What is the characteristic finding on a chest X-ray in a patient with pneumothorax?
All of the above
Which of the following patients is at high risk of developing a pneumothorax?
Premature neonates on mechanical ventilation
What is the primary difference between a simple pneumothorax and a spontaneous pneumothorax secondary to preexisting lung disease?
Presentation
What is the characteristic sign of a patient with a large pneumothorax?
Mediastinal shift to the opposite side
What is a potential complication of pneumothorax?
Cardiac tamponade
What is the primary goal of physiotherapy in treating pneumothorax?
To improve distribution of ventilation
Which of the following is a surgical treatment option for pneumothorax?
All of the above
What is the primary indication for hospitalization in patients with pneumothorax?
Large pneumothorax occupying >30% of the hemithorax
What is the most appropriate treatment for a patient with a traumatic pneumothorax?
Chest tube insertion
What is the immediate treatment for a tension pneumothorax?
Needle thoracostomy
What is the primary goal of supplemental O2 therapy in patients with pneumothorax?
To facilitate pleural air resorption
Which of the following patients is best treated with needle aspiration?
Clinically stable patients with primary spontaneous pneumothorax
Study Notes
Pneumothorax and Pleural Effusion
- Pleural infection is a common cause of pyo-pneumothorax, which is secondary to pressure fistula.
Clinical Presentation
- Symptoms depend on the amount of air leakage, extent of lung collapse, rate of development, etiology, and underlying clinical status of the patient.
- Common symptoms include chest pain, dyspnea, and dry or nonproductive cough.
- Simple pneumothorax may present with no symptoms and is found incidentally on a chest radiograph.
- Patients with spontaneous pneumothorax secondary to preexisting lung disease may have a dramatic presentation.
- Premature neonates on mechanical ventilation may develop pneumothorax due to positive pressure and respiratory system compliance.
Radiological Diagnosis
- Chest X-ray shows:
- Hyper-translucency between the lung and thoracic cage.
- Sharp border of the collapsed lung.
- Shifting of mediastinum to the opposite side.
- Chest US and Chest CT may also be used for diagnosis.
Complications
- Cardiac tamponade
- Cardiopulmonary arrest
- Hemothorax
- Pneumopericardium
- Pneumomediastinum
- Shock
- Tension pneumothorax
Treatment
- Surgical treatment includes:
- Supplemental O2 to facilitate pleural air resorption.
- Aspiration to aspirate air in the pleural cavity.
- Tube thoracostomy connected to a water seal device ± suction.
- Thoracoscopy (VATS) for mechanical pleurodesis.
- Large or complicated pneumothorax requires hospitalization and direct mechanical evacuation of pleural air.
- Clinically stable patients with primary spontaneous pneumothorax can be treated with needle aspiration.
- Clinically unstable patients and most patients with underlying lung disease require chest tube insertion.
- Traumatic pneumothorax requires immediate decompression with needle thoracostomy followed by tube thoracostomy.
Physiotherapy
- Aims to improve distribution of ventilation, reinflate collapsed lung areas, increase oxygenation, improve exercise tolerance, and maintain airway clearance.
- Gentle coughing can be performed in small pneumothorax.
- Large pneumothorax requires increase in lung expansion, allowing air entry during inspiration and leak during expiration, and decreasing venous return to the heart.
This quiz covers the symptoms and signs of pleural infection, including chest expansion, percussion sounds, and breath sounds. It also includes information on mediastinal shift and dyspnea.
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