3DefinitionA pneumothorax is a collection of free air in the chest outside the lung that causes the lung to collapse.
4incidenceSpontaneous pneumothorax affects about 9,000 persons each year in the U.S. who have no history of lung disease. This type of pneumothorax is most common in men between the ages of 20 and 40, particularly in tall, thin men. Smoking has been shown to increase the risk for spontaneous pneumothorax
5EtiologySpontaneous pneumothorax is caused by a rupture of a cyst or a small sac (bleb) on the surface of the lung (apical segment of upper lobe and or superior segment of lower lobe)May also occur following an injury to the chest wall such as a fractured rib, any penetrating injury (gun shot or stabbing),
6EtiologyA pneumothorax can also develop as a result of underlying lung diseases, including cystic fibrosis, chronic obstructive pulmonary disease (COPD), lung cancer, and infections of the lungs (pnemocysts carinii).
7Types of pneumothoraxA spontaneous pneumothorax, also referred to as a primary pneumothorax, occurs in the absence of a traumatic injury to the chest or a known lung diseaseA secondary (also termed complicated) pneumothorax occurs as a result of an underlying condition
8Tension PneumothoraxTension pneumothorax: The accumulation of air under pressure in the pleural space.The air enters the pleural cavity and is trapped there during expiration so the air pressure within the thorax mounts higher than atmospheric pressure, compresses the lung, may displace the mediastinum and its structures (including the lung) toward the opposite side, and cause cardiopulmonary impairment (decrease cardiac output)
9Clinical Presentation Sudden onset chest pain sharp in nature .Shortness of breathTachypneaTachycardiaCyanosisDecrease or abscent breath sounds
13TreatmentA small pneumothorax without underlying lung disease may resolve on its own.A large pneumothorax and a pneumothorax associated with underlying lung disease often require placement of a chest tube to evacuate the air
15HemothoraxHemothorax refers to a collection of blood within the pleural cavity.
16Etiology Traumatic Nontraumatic or spontaneous Blunt trauma Penetrating trauma (including iatrogenic)Nontraumatic or spontaneousNeoplasia (primary or metastatic)Blood dyscrasias, including complications of anticoagulationPulmonary embolism with infarctionTorn pleural adhesions in association with spontaneous pneumothorax
17Clinical Presentation Hemodynamic changes vary depending on the amount of bleeding and the rapidity of blood lossShock (blood loss > 750cc)A large enough collection causes the patient to complain of dyspnea
18Workup Chest radiography CT scan The upright chest radiograph is the ideal primary diagnostic study in the evaluation of hemothorax- Hemothorax is noted as a meniscus of fluid blunting the costophrenic angleCT scanCT scan is a highly accurate diagnostic study for pleural fluid or blood
20TreatmentIf a hemothorax is equal to or greater than the amount required to obscure the costophrenic sulcus or is found in association with a pneumothorax based on chest radiograph findings, it should be drained by tube thoracostomy
21TreatmentSurgical exploration in cases of traumatic hemothorax should be performed in the following circumstances:Greater than 1000 mL of blood is evacuated immediately after tube thoracostomy. This is considered a massive hemothorax.Bleeding from the chest continues, defined as mL/h for 2-4 hours.Persistent blood transfusion is required to maintain hemodynamic stability