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Spontaneous Pneumothorax

Spontaneous Pneumothorax

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Published by Qp Nizam

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Published by: Qp Nizam on Aug 22, 2010
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Title: spontaneous pneumothorax
19 years old Indian gentleman presented with shortness of breath, with sudden chest pain ±sharpstabbing pain, pleuritic in nature at the right chest. It associated with non-productive cough, andmalaise.
Background of the studyPneumothorax is the presence of air in the pleural cavity with associated lung collapse. Itis classified into spontaneous (occurring without an obvious preceding event), traumatic(direct or indirect), and iatrogenic. Spontaneous is the commonest condition in generalmedicine and is sub-classified as: (i) primary spontaneous pneumothorax (PSP) occurringin the absence of obvious lung disease and (ii) secondary spontaneous pneumothorax(SSP) was complicating a pre-existing lung disease.
 Primary spontaneous pneumothorax occurs in patients without underlying pulmonarydisease, classically in tall, thin young men in their teens and 20s. It is thought to be due tospontaneous rupture of subpleural apical blebs or bullae that result from smoking or thatare inherited. It generally occurs at rest, although some cases occur with activitiesinvolving reaching or stretching. Primary spontaneous pneumothorax also occurs duringdiving and high-altitude flying because of unequally transmitted pressure changes in thelung.
 Although some view primary spontaneous pneumothorax as more of a nuisance than amajor health threat, deaths have been reported. Secondary spontaneous pneumothoracescan be life threatening, depending on the severity of the underlying disease and the sizeof the pneumothorax. Compared with similar patients without pneumothorax, age-matched patients with COPD have a 3.5-fold increase in relative mortality when aspontaneous pneumothorax occurs. Mortality percentages in patients with COPD andspontaneous pneumothorax vary from 1-17% b.
Rationale and significance of choosing the caseThe researcher decided to choose this because of he wanted to understand more of thenature of this disease and its clinical presentations. Pneumothorax can be a medicalemergencies ±tension pneumothorax, and it can occurs spontaneously especially amongthe age of 18 to 40 years old and it is occurring more in men than women 6:1 for primaryand 3:1 for secondary pneumothorax. Therefore, there is a need for further understandingof pneumothorax through a case study in Malaysia.This is also an opportunity for the researcher to study about spontaneous pneumothoraxin joint hyperflexibility syndrome such as Marfan¶s syndrome and Ehlers-Danlossyndrome patient ±if it is prove to be.
Patients biography Name initials : MR. RBAge : 19 y/oSex : MaleReligion : HinduCivil status : SingleRace : IndianOccupation : IT sales assistanceAdmission : 21/12/2009Clerking : 21/12/2009 b.
Chief complaintPatient presented with chest pain accompanied with shortness of breath on emergencyadmission at HKL. He was then transferred to IPR for further management.
As mentioned, patient was presented with shortness of breath associated with suddenchest pain on the right chest. The characteristic were acute, sharp, and stabbing in nature.It worsened at attempt on inhaling, and movement of the right chest. He also experienced pleuritic pain. Patient claimed that he used to experience the same pain, but this is theworst. It was associated with shortness of breath on regular activity, cough, and malaise.Patient claimed that he had lost of weight from 60kg to 43kg prior to admission.Prior to admission, patient claimed that he was riding motorcycle with thin liningscovering his body, and has the habit of bathing at late night. He had history of similar  pain before. The first episode of pain started a few weeks before the admission, after came back from work at late night. The pain was similar in characteristic but thendissolved after a day ±he not experiencing any shortness of breath at then.During that eventful day, he was playing soccer with his friend in the evening. Heexperienced some trauma to the chest while playing soccer but there was no pain or injury suspected. He then continued to play soccer and jogging. After the game he wentfor bath and had a cold drink, settling down watching television. Suddenly, heexperienced the second episode of chest pain and worst, he had shortness of breath anddifficulty to breath. The pain got worse that he cannot even walk by himself ±carried byhis father and had to be taken to the hospital.

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