Pneumothorax

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• Collection of air between the visceral and
parietal pleura. Air in the pleural space will
allow the lung to move away from the chest
wall and the lung will partially deflate.

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 Types of pneumothorax
Spontaneous pneumothorax
• Occur at any age
• May be associated with
emphysema and chronic
bronchitis in men over 50
years
• Associated with
mechanical ventilation
due to PEEP
• Infections TB, pneumonia
• DF
• Marfan’s syndrome
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Traumatic pneumothorax
• Penetrating injury to
chest (stab or bullet
wound)
• Non-penetrating injury
to the chest wall as in
RTA
• During insertion of
central line
• Surgeries on chest wall
• During pleural
aspiration or biopsy
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Closed pneumothorax Open Pneumothorax
• Chest wall remains • Chest wall open with
intact with air leak presenting
in pleura pneumothorax

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 Pathology
• Air escapes into pleural cavity and reduces the
subatmospharic pressure(less negative pressure)
lung collapse

• When the hole in pleura closes, the air become

absorbed and the lung gradually re-expands

• Sometimes this not reversed and the hole in the

pleura becomes like a valve.

• Air enters the pleural cavity on inspiration but cannot

escape expiration

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• The lung remains collapsed and air accumulates in
the pleural cavity; pressure increases there is
displacement of the heart together with
compression of the other lung and great vessels

Tension pneumothorax

• Needs to be treated as an emergency by needle

aspiration and thereafter by insertion of a drain
connected to an underwater seal.

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 Clinical features
• Sudden onset
• Severe chest pain
• Progressive breathlessness
• Diminished chest movement
• Absence of breath sounds over affected side
• Subcutaneous emphysema may develop at the
time of the pleural air leak or following the
insertion of an intercostal drain when air results
into the subcutaneous tissue
• Subcutaneous air results in a crackling sensation on
palpation

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 Investigation

• CXR: lung marking may not be clearly visible

Signs of collapsed lung can be identified

Physical examination-
• Auscultation: decreased or absent breath sounds +
reduced air entry

• On percussion hyper resonance

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 Medical and surgical treatment

• Mostly treated in medical emergency

• Aim of treatment: to relive pressure on the
lung and allow to expand
• O2 supplement to relive SOB
• Treatment of underlying lung pathology
• In case of small pneumothorax close
monitoring and bed rest
• ICD may be along with Heimlich valve (one
way valve designed for ambulatory treatment
of pneumothorax)
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 Physiotherapy
Aims:
• To prevent lung collapse
• To relive dyspnea
• To remove secretions
• To improve ventilation/perfusion
• TO reduce WOB
• Care of ICD
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