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Pneumothorax: Difference between revisions
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'''Pneumothorax''' (PTX) refers to the presence of air in the pleural space, between the lung and the chest wall. It may happen spontaneously or secondary to [[emphysema]], [[lung abscess]] or a fractured rib. | <section begin="radiology" />'''Pneumothorax''' (PTX) refers to the presence of air in the pleural space, between the lung and the chest wall. It may happen spontaneously or secondary to [[emphysema]], [[lung abscess]] or a fractured rib. | ||
The pressure in the pleural cavity is normally negative to allow the lungs to expand in it. When it suddenly becomes filled with air the pressure in the pleural cavity will become equal with atmospheric pressure, causing the lung to collapse. | The pressure in the pleural cavity is normally negative to allow the lungs to expand in it. When it suddenly becomes filled with air the pressure in the pleural cavity will become equal with atmospheric pressure, causing the lung to collapse. | ||
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'''Tension pneumothorax''' is a potentially life-threatening form of pneumothorax and a medical emergency. In tension PTX air enters the pleural cavity during inspiration but cannot leave during expiration, due to the formation of a one-way valve. | '''Tension pneumothorax''' is a potentially life-threatening form of pneumothorax and a medical emergency. In tension PTX air enters the pleural cavity during inspiration but cannot leave during expiration, due to the formation of a one-way valve. | ||
Secondary pneumothorax occurs when there is a rupture of the lung close to the pleural surface that allows inhaled air to enter the pleural cavity. | Secondary pneumothorax occurs when there is a rupture of the lung close to the pleural surface that allows inhaled air to enter the pleural cavity.<section end="radiology" /> | ||
== Etiology == | == Etiology == | ||
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In tension pneumothorax air enters the pleural cavity during inspiration but cannot leave during expiration, due to the formation of a one-way valve. This causes the pressure inside the pleural cavity increases with each inspiration, and this increasing pleural pressure compresses venous structures, reducing venous return to the heart and shifting the mediastinum to the contralateral side. Any type of pneumothorax can progress into tension pneumothorax if the pleura or chest wall forms a one-way valve. | In tension pneumothorax air enters the pleural cavity during inspiration but cannot leave during expiration, due to the formation of a one-way valve. This causes the pressure inside the pleural cavity increases with each inspiration, and this increasing pleural pressure compresses venous structures, reducing venous return to the heart and shifting the mediastinum to the contralateral side. Any type of pneumothorax can progress into tension pneumothorax if the pleura or chest wall forms a one-way valve. | ||
<section begin="radiology" /> | |||
== Clinical features == | == Clinical features == | ||
Patients with pneumothorax present with sudden, severe stabbing chest pain and, if the PTX is large enough, dyspnoea. Physical examination may reveal decreased breathing sounds and hyperresonant percussion on the affected side. | Patients with pneumothorax present with sudden, severe stabbing chest pain and, if the PTX is large enough, dyspnoea. Physical examination may reveal decreased breathing sounds and hyperresonant percussion on the affected side. | ||
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Suspected tension pneumothorax is a clinical diagnosis does not undergo imaging. They proceed immediately to treatment. Should a chest x-ray be made, a mediastinal shift and tracheal deviation toward the contralateral side will be present. The ipsilateral diaphragm may be flattened or inverted. | Suspected tension pneumothorax is a clinical diagnosis does not undergo imaging. They proceed immediately to treatment. Should a chest x-ray be made, a mediastinal shift and tracheal deviation toward the contralateral side will be present. The ipsilateral diaphragm may be flattened or inverted. | ||
<section end="radiology" /> | |||
== Treatment == | == Treatment == | ||
Patients with stable, mildly symptomatic, small, spontaneous pneumothorax may be treated conservatively, as they usually heal spontaneously. In case of significant symptoms, haemodynamic instability, large PTX, or trauma, a chest tube should be placed. | Patients with stable, mildly symptomatic, small, spontaneous pneumothorax may be treated conservatively, as they usually heal spontaneously. In case of significant symptoms, haemodynamic instability, large PTX, or trauma, a chest tube should be placed. | ||