Air in the pleural space.
Usually caused by a rupture of the pleura and can be sponatneous.
- Lung - asthma, TB, COPD, pneumonia, cancer, abscess, CF, fibrosis
- Non-lung - connective tissue: sarcoidosis; trauma: both iatrogenic and non-iatrogenic
Being a young, thin man.
Medical Emergency - Tension pneumothorax is where an artificial valve means air can't get back out from in the pleural space e.g. a really quick and deadly pneumothorax. Same symptoms as below but really bad.
- Respiratory - shortness of breath, pleuritic chest pain, diminished breath sounds and hyperesonant over affected area, reduced chest expansion
- Cardiac - tachycardia, hypotension
- Neck - deviated trachea, distended neck veins
Do an expiratory CXR (done whilst they've fully exhaled). Look for an area devoid of markings on the periphery of the collapsed lung.
Acute; primary pneumothorax
- If no SOB, <2cm air on CXR - send home
- If successful aspiration - send home
- If successful repeat aspiration - send home
- If not - chest drain
Acute; secondary pneumothorax
When the pneumothorax is caused by something else, then you need to do slightly different stuff.
- If 'SOB AND >50y AND >2cm air on CXR - chest drain
- Otherwise aspiration - succesful, admit for 24h
- If unsuccessful aspiration - chest drain
Sometimes this may be necessary: bilateral; lung fails to expand after drain; 2 or more previous pneumothoraces on that side; or history of pneumothorax on same side.