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TENSION PNEUMOTHORAX
Pediatric Respirology Division
Helmi Lubis
Ridwan M. Daulay
Wisman Dalimunthe
Rini S. Daulay
Pneumothorax
Abnormal collection of air in the
pleural space outside of the lung
Air enter the pleural space by a leak in
either the visceral or parietal pleura
Classification of Pneumothorax:
Spontaneous:
Primary
Secondary
Traumatic
Iatrogenic
Spontaneous Pneumothorax
Primary occurs without trauma or
underlying lung disease
Secondary complication of
underlying lung disorder:
Pneumonia
Pulmonary abscess
Asthma
Foreign body in the lung
Traumatic Pneumothorax
Result of blunt or penetrating trauma
to the chest wall
Injury from a diagnostic or
therapeutic procedure Iatrogenic
Pneumothorax
Iatrogenic Pneumothorax
Complicate of:
Tracheostomy
Thoracentesis
Transbronchial byopsi
Catamenial Pneumothorax
Unusual condition
Associated with menses
10
Clinical Manifestations
Sudden onset of chest pain
Tachypnea
Dyspnea
Tachycardia
Cyanosis
11
Phisical Examination
Involved lung:
Decreased breath sounds
Percussion: hyperresonance
12
Diagnosis
Radiographic examination:
Chest X Ray AP and lateral:
Air in the pleural space outlining the visceral
pleura/pleura line
Hyperlucency
Attenuation of vascular & lung marking on the
affected side
CT of the chest:
Detect bullae & blebs recurrent Pneumothorax
13
14
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Evidence of tension:
Shift of mediastinal structure away
from the side of air leak
Basis of evidence of:
Circulatory compromise
Hearing ahiss or rapid exit of the
air with the insertion of
thoracostomy tube
16
17
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Definitive Treatment
Closed thoracotomy:
Drainage trapped air through a catheter
External opening in a dependent position
under water adequate to re-expand the
lung
Open thoracotomy:
Plication of blebs
Closure of fistula
Stripping of the pleura apical lung
19
Chemical pleurodesis:
Talc
Tetracycline
Silver Nitrate
Pleural pain analgetic treatment
20