• Pneumothorax: is defined as the presence of air or gas in the pleural cavity
• Secondary spontaneous pneumothorax (SSP) occurs in people with a wide variety of parenchymal lung diseases.
. Primary spontaneous pneumothorax (PSP) occurs in people without underlying lung disease and in the absence of an inciting event.Types:
2:1. the male-to-female ratio of age-adjusted rates is 6. and PSP is rarely observed in people older than 40 years. Peak incidence is in the early twenties.• Sex • For primary spontaneous pneumothorax (PSP).2:1. the male-to-female ratio of age-adjusted rates is 3. • Age • Primary spontaneous pneumothoraces (PSPs) occur in people aged 20-30 years. For a secondary spontaneous pneumothorax (SSP). • Secondary spontaneous pneumothoraces (SSPs) occur more frequently in patients aged 60-65 years
Risks factors for primary spontaneous pneumothorax (PSP
– Tall. thin stature in a healthy person – Marfan syndrome – Pregnancy – Smoking – Familial pneumothorax
• Familial spontaneous pneumothorax has been described as an autosomal dominant inheritance with incomplete penetrance. One family study reported 9 cases of SP among 54 members ascertained
• Diseases and conditions associated with secondary spontaneous pneumothorax
– Chronic obstructive lung disease – Asthma – HIV/AIDS with Pneumocystis jiroveci (PCP) infection: – Necrotizing pneumonia – Bronchogenic carcinoma – Metastatic malignancy
. but also genitourinary cancers and primary lung cancer.
Causes of iatrogenic pneumothora
– Transthoracic needle aspiration biopsy of pulmonary nodules – Transbronchial biopsy – Thoracentesis – Central venous catheter insertion – Intercostal nerve block – Tracheostomy – Cardiopulmonary resuscitation – Positive pressure ventilation and ARDS in the ICU – Acupuncture – Nasogastric feeding tube placement
.Penetrating and nonpenetrating injury – Rib fracture – High-risk occupation (eg.Causes of traumatic pneumothorax
– Trauma .
• General appearance
– Diaphoretic – Splinting chest wall to relieve pleuritic pain – Cyanotic (with tension pneumothoraces)
If faster than 135 beats per minute (bpm).Jugular venous distension (tension pneumothorax) • Neurologic .Altered mental status
. tension pneumothorax is likely – Pulsus paradoxus – Hypotension (often with tension pneumothorax) – Asymmetric lung expansion .Mediastinal and tracheal shift to the contralateral side with a large tension pneumothorax – Distant or absent breath sounds – Hyperresonance on percussion – Decreased tactile fremitus
• Cardiovascular .• Vital signs
– Tachypnea – Tachycardia (most common finding) .
– Life threatening: Pneumothorax that causes hemodynamic instability is life-threatening and must be treated immediately with tube thoracostomy
• Patient's presentation
– Asymptomatic (incidental finding): Treatment decisions are guided by estimate of long-term recurrence risk. – Clinically fragile: Treatment is guided by local practice patterns for air evacuation and observation. – Symptomatic but clinically stable: Treatment is guided by local resources and conventions for the site of care. Comorbid conditions may preclude observation because of decreased cardiopulmonary reserve.